Delirium - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DELIRIUM A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Delirium: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00342-2 1. Delirium-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on delirium. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DELIRIUM .................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Delirium........................................................................................ 7 E-Journals: PubMed Central ....................................................................................................... 25 The National Library of Medicine: PubMed ................................................................................ 26 CHAPTER 2. NUTRITION AND DELIRIUM ........................................................................................ 65 Overview...................................................................................................................................... 65 Finding Nutrition Studies on Delirium ...................................................................................... 65 Federal Resources on Nutrition ................................................................................................... 66 Additional Web Resources ........................................................................................................... 67 CHAPTER 3. ALTERNATIVE MEDICINE AND DELIRIUM .................................................................. 69 Overview...................................................................................................................................... 69 National Center for Complementary and Alternative Medicine.................................................. 69 Additional Web Resources ........................................................................................................... 73 General References ....................................................................................................................... 75 CHAPTER 4. DISSERTATIONS ON DELIRIUM .................................................................................... 77 Overview...................................................................................................................................... 77 Dissertations on Delirium ........................................................................................................... 77 Keeping Current .......................................................................................................................... 78 CHAPTER 5. PATENTS ON DELIRIUM .............................................................................................. 79 Overview...................................................................................................................................... 79 Patents on Delirium..................................................................................................................... 79 Patent Applications on Delirium................................................................................................. 81 Keeping Current .......................................................................................................................... 81 CHAPTER 6. BOOKS ON DELIRIUM .................................................................................................. 83 Overview...................................................................................................................................... 83 Book Summaries: Federal Agencies.............................................................................................. 83 Book Summaries: Online Booksellers........................................................................................... 91 Chapters on Delirium .................................................................................................................. 91 CHAPTER 7. MULTIMEDIA ON DELIRIUM ....................................................................................... 95 Overview...................................................................................................................................... 95 Video Recordings ......................................................................................................................... 95 Audio Recordings......................................................................................................................... 98 CHAPTER 8. PERIODICALS AND NEWS ON DELIRIUM .................................................................... 99 Overview...................................................................................................................................... 99 News Services and Press Releases................................................................................................ 99 Newsletter Articles .................................................................................................................... 101 Academic Periodicals covering Delirium ................................................................................... 102 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 103 Overview.................................................................................................................................... 103 U.S. Pharmacopeia..................................................................................................................... 103 Commercial Databases ............................................................................................................... 104 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 109 Overview.................................................................................................................................... 109 NIH Guidelines.......................................................................................................................... 109 NIH Databases........................................................................................................................... 111 Other Commercial Databases..................................................................................................... 113 APPENDIX B. PATIENT RESOURCES ............................................................................................... 115 Overview.................................................................................................................................... 115

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Patient Guideline Sources.......................................................................................................... 115 Finding Associations.................................................................................................................. 117 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 119 Overview.................................................................................................................................... 119 Preparation................................................................................................................................. 119 Finding a Local Medical Library................................................................................................ 119 Medical Libraries in the U.S. and Canada ................................................................................. 119 ONLINE GLOSSARIES................................................................................................................ 125 Online Dictionary Directories ................................................................................................... 129 DELIRIUM DICTIONARY .......................................................................................................... 131 INDEX .............................................................................................................................................. 177

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with delirium is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about delirium, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to delirium, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on delirium. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to delirium, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on delirium. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DELIRIUM Overview In this chapter, we will show you how to locate peer-reviewed references and studies on delirium.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and delirium, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “delirium” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Measuring Delirium Severity in Older General Hospital Inpatients Without Dementia: The Delirium Severity Scale Source: American Journal of Geriatric Psychiatry. 6(4): 296-307. Fall 1998. Summary: This article describes a study that evaluated the validity, reliability, and sensitivity to change of the Delirium Severity Scale (DSS). Researchers administered the DSS to hospitalized patients both with delirium and no dementia and to controls. Data showed the scores to be inversely correlated with experts' ratings of severity at all three time points examined. The DSS showed significant improvement over time and significant correlation with improvement in expert ratings. The authors conclude that the DSS shows promise as a reliable measure that is sensitive to changing symptoms and may be useful as an aid to understanding the pathophysiology of delirium. It also

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may be effective for periodic assessment of medical interventions. 3 figures, 2 tables, 32 references. (AA-M). •

Differential Diagnosis of Dementia, Delirium and Depression: Implications for Drug Therapy Source: Drugs and Aging. 5(6): 431-445. December 1994. Summary: This article discusses the differential diagnosis, evaluation, and treatment options for dementia, delirium, and depression. It presents the clinical features and causes of each disorder and the neuropsychological and laboratory tests used in diagnosis. Comprehensive clinical evaluation is necessary because these disorders are not mutually exclusive. Furthermore, physical diagnoses, such as chronic obstructive lung disease, congestive heart failure, stroke, and endocrine disorders are frequently associated with depressive symptoms. Laboratory testing is required to exclude concurrent metabolic, endocrine and infectious disorders, and drug effects. Imaging studies should be obtained selectively in patients with signs and symptoms, such as focal neurological findings and gait disturbances, which are suggestive of structural lesions: stroke, subdural hematoma, normal pressure hydrocephalus, and brain tumors. Appropriate management involving pharmacological and nonpharmacological measures could result in significant improvement in most patients with these syndromes. In delirious patients the underlying illness may be treated concomitantly with the use of psychotropics, if necessary. Although no current medications have been shown to have a significant effect on the functional status of patients with the two most common causes of dementia, Alzheimer's disease (AD) and multi-infarct dementia, the management of concomitant illness in these patients may result in improved function for as long as a year. Tacrine (Cognex) improves cognitive function slightly in selected patients with AD over short periods. Finally, the treatment of depression with medications or electroconvulsive therapy may result in significant reductions in mortality and morbidity. 4 tables, 43 references. (AA-M).

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Delirium and Dementia; Are They Distinct? Source: Journal of the American Geriatrics Society. 44(8): 1001-1002. 1996. Summary: This article underlines the need to distinguish between delirium and dementia, and it shows the similarities and differences between these two syndromes. The authors indicate that the most important difference between the two is that if a patient survives, delirium will improve and dementia will not. Delirium is described as a clinical syndrome distinct from that of dementia. The traditional features that distinguish delirium from dementia are outlined, including an abrupt onset, perceptual disturbances, fluctuations, and clouded consciousness. The authors cite research that questions current definitions of delirium and calls for further research to clearly distinguish between dementia and delirium. 1 figure, 23 references.

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Delusions, Delirium, and Cognitive Impairment: The Challenge of Clinical Heterogeneity Source: Journal of the American Geriatrics Society. 40(8): 848-849. August 1992. Summary: This editorial discusses the difficulties of studying complex behavioral syndromes, such as those found in Alzheimer's disease. The author suggests that the reason for these difficulties is the heterogeneity of behavioral phenomena. Heterogeneity is also present in dementia. For example, the relationship between severity of cognitive loss and prevalence of psychotic symptoms in persons with

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Alzheimer's disease seems to vary, depending on clinical subtypes, as defined by age of onset and presence of extrapyramidal signs. In one study, psychotic symptoms were most prevalent in persons with the greatest cognitive impairment, but this was not always the case. Persons whose dementia began prior to age 65 and those who manifested extrapyramidal signs had delusions even when mildly impaired. There are also studies that suggest that demented patients with delusions have biological features that distinguish them from demented patients without delusions. The author notes that delirium, like dementia, is polymorphic in its manifestations. Acknowledging that heterogeneity exists and attempting to understand its sources can help improve understanding of the mechanisms underlying delusions, delirium, and other behavioral disturbances. 13 references. •

Introduction: the Puzzles of Delirium (editorial) Source: Journal of Geriatric Psychiatry and Neurology. 11: 115-117. Fall 1998. Summary: This editorial states that delirium increasingly is recognized as a pervasive problem among elderly populations. The author discusses studies and articles presented in this issue of the Journal of Geriatric Psychiatry and Neurology that outline the demographics and costs of delirium and provide a full-scale meta-analysis of studies addressing prevention, treatment, and outcomes in delirium. The editorial author discusses the problems for researchers and clinicians of not understanding the pathology of delirium, not being able to categorize it optimally, and not having effective treatments for it. 10 references.

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Delirium: Making the Diagnosis, Improving the Prognosis Source: Geriatrics. 54(3): 28-42. March 1999. Summary: This journal article describes a practical approach to the diagnosis and management of delirium in the older patient. The authors define delirium and discuss potential causes and risk factors. They provide information on the bedside differential diagnosis of delirium, dementia, and depression. The authors describe how to evaluate a patient for delirium using such techniques as the Confusion Assessment Method rating scale, brain studies, and lumbar puncture. Management issues include prevention, identification of underlying causes, supportive care, and pharmacologic intervention; and the authors discuss the relationship between prognosis and prompt management of symptoms. The implications of these findings on primary care physicians are discussed. 3 figures, 4 tables, and 21 references.

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Consequences of Not Recognizing Delirium Superimposed on Dementia in Hospitalized Elderly Individuals Source: Journal of Gerontological Nursing. p. 30-40. January 2000. Summary: This journal article describes a study of delirium superimposed on dementia in hospitalized elderly people. Data were collected through observations of interactions among hospitalized older patients, family members, and health care providers including daily mental status testing of the patients, and semistructured interviews with the families and health care providers. The prevalence of delirium was 60 percent. The incidence of delirium was 30 percent. The presence of delirium was associated with new onset incontinence, lower baseline Mini-Mental State Examination scores, depression, weight loss, and comorbidity. Five of the patients admitted with delirium superimposed on dementia were readmitted to the hospital within 30 days, compared with none of the patients with delirium in the absence of dementia. Delirium

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superimposed on dementia was less likely to be recognized by nurses and physicians. The implications for nursing practice are discussed. 3 tables, 31 references. •

Donepezil Improves Symptoms of Delirium in Dementia: Implications for Future Research Source: Journal of Geriatric Psychiatry and Neurology. 11: 159-161. Fall 1998. Summary: This journal article discusses a case study of delirium, complicated by preexisting dementia, that was resolved rapidly following initiation of the cholinesterase inhibitor donepezil. The authors suggest that cholinergic dysfunction may have played a role in the etiology of the patient's delirium. Delirium is a common complication of dementia that may produce agitation, which may be refractory to conventional medications such as antipsychotics and benzodiazepines. Delirium may also produce considerable morbidity. Delirium is not always reversible and there is no specific treatment for persistent delirium; the main treatment approach is to treat the underlying medical problem. The authors state that future research needs to be directed at the issue of cholinergic activity in delirium through monitoring serum anticholinergic activity and its response to procholinergic therapy. 17 references. (AA-M).

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Differentiating Behavioral Disturbances of Dementia From Symptoms of Delirium Source: International Psychogeriatrics. 8(Supplement 3): 425-427. 1996. Summary: This journal article discusses the challenge of differentiating behavioral disturbances of dementia from symptoms of delirium. It reviews the similarities between these two conditions that can complicate diagnosis, including the characteristic slowing of electroencephalographic activity, altered sleep cycles, types of behavioral problems, and diurnal variations in symptoms. It then describes potential signs of delirium, including the abrupt onset of symptoms, heightened or reduced attention in a patient with preexisting dementia, prominent fluctuations in symptoms, the occurrence of new hallucinations, altered psychomotor activity, altered prosody of speech, and tremor or asterixis. The article also describes some unusual causes of delirium in patients with dementia, including the interaction of certain drugs with grapefruit juice, carbon monoxide poisoning, folk medications, eye drops with beta-blocker properties, the consumption of alcohol or sedatives, hypoxia, urinary retention, and fecal impaction. 8 references.

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Delirium Phenomenology Illuminates Pathophysiology, Management, and Course Source: Journal of Geriatric Psychiatry and Neurology. 11: 150-156. Fall 1998. Summary: This journal article examines current approaches to the investigation of delirium phenomenology and how current findings illuminate our understanding of delirium. The authors discuss; the range and frequency of clinical features associated with delirium; the delineation of delirium from dementia; the definitional importance of specific symptoms of delirium; the interrelationship of delirium symptoms; the subtypes of delirium; the existing evidence for a relationship "between phenomenology and pathophysiology; management, course, and clinically identified etiology." The article concludes with recommendations for five areas of future investigation. 1 table, 66 references (AA-M).

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Delirium Episodes During the Course of Clinically Diagnosed Alzheimer's Disease Source: Journal of the National Medical Association. 91(11): 625-630. 1999.

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Summary: This journal article examines the occurrence of delirium during the course of clinically diagnosed Alzheimer's disease (AD). Researchers conducted a retrospective chart review for 122 AD patients who had participated in a longitudinal dementia study at the Mayo Clinic in Rochester, Minnesota, from 1965 to 1970. A psychiatrist assigned DSM-III-R diagnoses based on the symptoms recorded in records from the Mayo clinic, state psychiatric hospitals, and community hospitals. Thirty patients (25 percent) were found to have had a delirium episode during the course of their AD; half of these episodes occurred in patients aged 80 to 89 years. Among patients with a delirium episode, 50 percent died within 1 year of the episode and 64 percent died within 2 years. Ten of 13 patients (77 percent) had multiple delirium episodes within 2 years of their deaths. A psychiatric consultation was requested in only 17 cases (14 percent); 88 percent of these patients received a diagnosis of late-onset AD. Eighty-two percent of patients with a delirium episode were treated with psychopharmacology, and in most cases their symptoms resolved within 48 hours. 4 tables, 27 references. •

Delirium: Prevention, Treatment, and Outcome Studies Source: Journal of Geriatric Psychiatry and Neurology. 11: 126-137. Fall 1998. Summary: This journal article reviewed evidence related to the prevention, treatment, and outcome of delirium. The literature review process consisted of a systematic search on each topic, assessment of the validity of the studies reviewed, and an examination of each studies' results. The literature search identified 10 studies on prevention, 13 on treatment, and 15 on outcome. Interventions appeared to be moderately effective in preventing delirium in young and old surgical patients but not in elderly medical patients. Systematic intervention programs and special nursing care appeared to add significant benefits to traditional medical care in young and old surgical patients and modest benefits in elderly medical patients. Haloperidol, chlorpromazine, and mianserin appeared useful in controlling the symptoms of delirium in surgical and medical patients, and good levels of premorbid function appeared to be related to better outcomes. In conclusion, directions for further research on the treatment of delirium are suggested. 6 tables, 65 references. (AA-M).

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Resolving the Delirium Dilemma Source: Nursing. 41-46. October 1999. Summary: This journal article uses a case example to examine the problem of delirium and its appropriate management in older people. After presenting the case history, it lists some of the factors that can increase the risk for delirium, outlines diagnostic criteria, and distinguishes between delirium and dementia. Then, it discusses the potential causes of delirium in the elderly, behavioral manifestations, natural course, use of physical and chemical restraints, prevention, and the association between pain and delirium. It includes a diagnostic algorithm that can help in the assessment of delirium. Finally, the article suggests strategies for managing the older patient with delirium. 1 figure, 1 table, 4 references.

Federally Funded Research on Delirium The U.S. Government supports a variety of research studies relating to delirium. These studies are tracked by the Office of Extramural Research at the National Institutes of

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Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to delirium. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore delirium. The following is typical of the type of information found when searching the CRISP database for delirium: •

Project Title: AGING AND PERIOPERATIVE OUTCOMES Principal Investigator & Institution: Leung, Jacqueline M.; Anesthesia & Perioperative Care; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 01-MAR-2001; Project End 28-FEB-2006 Summary: (Applicant s abstract) People > 65 years of age are expected to exceed 50 million or 20% of the total population by the end of the century. The elderly undergo approximately 40% of all surgical procedures, amounting to an annual expenditure of over $60 billion. Our previous work demonstrated the postoperative in-hospital morbidity rate in octogenarians undergoing non- cardiac surgery to be 25%. By multivariate logistic regression, a history of neurological disease, congestive heart failure and arrhythmia increased the odds of developing any adverse postoperative events. Our work here focuses on the identification of the predictors of perioperative complications in geriatric surgical patients followed by clinical trials to modify the risk factor(s) in order to improve perioperative outcome. Four integrated clinical studies are planned: 1) A prospective, longitudinal cohort study of 600 consecutive geriatric surgical patients undergoing non-cardiac surgery. This study aims to determine the impact of perioperative complications on the functional status and long-term survival of the elderly surgical patients by measuring pre-defined in-hospital adverse postoperative outcomes, and functional and survival status at two years postoperatively. 2) A prospective cohort study of 200 geriatric patients undergoing non-cardiac surgery. This study aims to determine the accuracy of preoperative clinical methods of assessing heart function as compared to echocardiography; and also the prognostic relationship between preoperative diastolic dysfunction and postoperative heart failure. 3) A prospective cohort study of 300 patients undergoing coronary artery bypass graft surgery. This study aims to determine if left atrial dysfunction as measured by intraoperative transesophageal echocardiography provides incremental value in predicting the occurrence of postoperative atrial fibrillation when compared with routine clinical data. In later years, we will perform 4) a randomized, clinical trial of regional versus general anesthesia in 500 elderly patients undergoing orthopedic surgery. This study aims to determine the incidence of postoperative cognitive dysfunction and delirium between regional versus general anesthesia after controlling for intraoperative anesthetic and hemodynamic management and postoperative pain

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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management. Postoperative cognitive function and delirium will be measured by standard neuropsychological tests and the Confusion Assessment Method. We believe that our studies will provide important results contributing ultimately to the improvement of perioperative outcomes in geriatric patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CENTER FOR PATIENT SAFETY AT THE END OF LIFE Principal Investigator & Institution: Lynn, Dorcas J.; Director; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: The RAND Center to Improve Care of the Dying will generate a new Developmental Center for Evaluation and Research in Patient Safety: the Center for Patient Safety at the End of Life. The Center will be led by Dr. Joanne Lynn and will build on experts from RAND Health, the Institute for Healthcare Improvement, The Veterans Health Administration, Kaiser Permanente, and other organizations. These leaders in health services research and quality improvement are committed to making care safe and reliable for persons with serious eventually fatal chronic illness, staring with those with advanced chronic heart or lung failure. Although they have the potential to affect the health care provided to all Americans, medical errors and other lapses in patient safety disproportionately affect the oldest and sickest of patients, both in their incidence and in the severity of the consequences. Serious, long-term illness occurs mostly at the end of life-leading to more errors, adverse effects, and erratic and unsafe treatment patients in a population that is most in need of safe, reliable, coordinated care. Seriously ill patients are often subjected to a repeated series of mistakes, including: non-treatment of pain, delirium, and other symptoms; routine discontinuity within and among provider programs; location of care for provider convenience, rather than efficiency or family support; and a lack of focus on advance care planning. The Center aims to help improve the reliability of health care dramatically, by building capacity for improvement through effective change methods and knowledge about safe and correct care of individuals with chronic heart failure of chronic obstructive pulmonary disease. During Phase I, the Center will build a strong team, develop ties to health delivery systems, produce educational materials, and develop a proposal for at least one pilot study that it will carry out during Years 2 and 3. In Phase II, the Center will implement the pilot study(ies), present educational materials, and develop a dissemination for pilot study findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CNS MECHANISMS IN COCAINE RELATED SUDDEN DEATH Principal Investigator & Institution: Mash, Deborah C.; Professor; Neurology; University of Miami-Medical Box 248293 Coral Gables, Fl 33124 Timing: Fiscal Year 2003; Project Start 10-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Cocaine is a reinforcing drug with high abuse liability and substantial morbidity and mortality. Cocaine's potent actions on dopamine (DA), serotonin (5-HT) and norepinephrine (NE) transport are well known. However, the relationship between the long-term effects of chronic cocaine abuse and the regional neuroadaptive changes in human brain is less certain. Because the transit of cocaine from the Caribbean corridor to the United States frequently occurs through South Florida, Metropolitan Miami-Dade County has continued to have a high incidence of cocaine-related deaths. In collaboration with the Miami-Dade County Medical Examiner

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Department, we have developed a bank of postmortem brain specimens from cocaine users. Based on a retrospective case control analysis of the toxicology reports, scene descriptions, supplemental background information, interviews with next-of-kin, and autopsy findings, we assign cases into three groups: cocaine-related sudden death, excited cocaine delirium, and drug-free control subjects. The proposed studies are designed to identify neuroadaptive and neurodegenerative changes in biogenic amine pathways in the postmortem human brain. Neuroadaptation and neurodegeneration in DA, 5-HT and NE systems are central to the vulnerability, progression and long-term consequences of addictive behavior. DAergic signaling underlies the reinforcing properties of cocaine, while serotonergic dysfunction may be associated with behavioral disinhibition and negative mood states. Recent studies of the noradrenergic system suggest that a dysregulation of NE transport by cocaine may contribute to cerebrogenic cardiovascular and autonomic disturbances that lead to sudden death. Specifically, we plan to test the following hypotheses: 1.) DA transporter upregulation occurs in parallel with an increase in the expression of alpha-synuclein protein in DA and NE neurons. 2.) Asymmetric changes in NE transporter expression occurs in higher brain autonomic centers (insula and amygdaloid subnuclei) in cocaine-related sudden death as compared to age-matched drug-free control subjects. This neuroadaptive change in NET will be a specific marker of cocaine toxicity. 3.) Regulatory changes in biogenic amine transporters and kappa opioid receptor numbers will show lateral asymmetry in the amygdala and anterior insular cortex. 4.) Changes in particular biogenic amine transporters and gene transcripts are specific to the pathology of cocaine excited delirium. The power of the proposed study derives from an integration of molecular and anatomical approaches in examining postmortem human brain from chronic cocaine users. Together, these studies will provide a molecular and circuit-based accounting of the abnormalities in biogenic amine systems in cocaine toxicity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE IMPAIRMENT IN THE ICU: EVALUATION AND OUTCOMES Principal Investigator & Institution: Ely, E W.; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: (From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients

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and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--DEMONSTRATION AND INFORMATION DISSEMINATION Principal Investigator & Institution: Rosenberg, Roberta; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: (provided by the applicant) The Demonstration/information Dissemination Project (DIDP) will work closely with IDS, pilot investigators and the Recruitment Core to translate the work of the OAIC into improvements in health care practice in diverse communities. It will utilize a well-established network of local, regional, and national agencies and institutions to disseminate research findings and interventions to the lay public, paraprofessionals, and professionals. DIDP activities build on ten years of experience and utilize new models of cultural competence in three areas: prerecruitment education and outreach, recruitment and retention of diverse study participants, and post study information dissemination. The DIDP will also leverage HRSA funding for the Harvard Upper New England Geriatric Education Center (HUNEGEC) to accomplish the following goals: 1) To provide Community Education about disease prevention and health maintenance, with a specific focus on the topics investigated in the 3 IDSs, namely gait, balance and falls, cardiovascular risk factors, memory loss, and delirium; 2) To design and implement local, regional, and national post-study information dissemination to medical professionals, staff of community based organizations, and lay consumers; 3) To establish formal research partnerships with a targeted group of community based organizations serving culturally diverse populations; and 4) To design and implement a "Cultural Competence in Geriatric Research" training module for new and established clinical investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DELIRIUM AMONG THE ELDERLY IN RURAL LTC FACILITIES Principal Investigator & Institution: Culp, Kennith R.; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 15-APR-2000; Project End 30-SEP-2003 Summary: (Adapted from the Applicant's Abstract): Delirium is differentiated from chronic confusion or Alzheimer's dementia (AD) and acute psychosis by an abrupt onset, a reduced ability to maintain attention, and a potential clinical reversibility.

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Delirium

Despite the significance of delirium in the elderly, little is known about the prevalence of this illness in long-term care (LTC), especially in rural LTC facilities. Although delirium is a reversible cognitive disturbance in the elderly, the scope of the problem in LTC is largely neglected in the literature and referred to by other labels (e.g., pseudosenility and acute brain syndrome). A primary care provider is generally not immediately available in the rural LTC facility to diagnose this illness. As a result, elders with delirium in LTC receive inadequate care and treatment. The purpose of this investigation is to estimate the prevalence of delirium in the LTC setting and to identify the natural history (i.e. onset, duration, and resolution), and risk factors for this illness. A longitudinal design, conducted in two phases, will be used. Phase I will consist of 30 days of follow-up (i.e., to measure period prevalence) and Phase II will consist of a oneyear follow-up comparing mortality, rate of hospitalization, an in-house fall rates between delirium subjects and non-case subjects. A two-stage cluster sampling strategy will be used. The procedure for screening to identify cases will incorporate instruments with established psychometric properties, specifically the Confusion Assessment Method (CAM) and the NEECHAM. Baseline cognitive assessments will be completed on subjects using the Mini Mental Status Exam (MMSE). A board certified geropsychiatrist consultant will review a random sample of both cases and non-cases so that sensitivity and specificity measures can be obtained for the algorithm. Numerous physiological measures will be taken including serum electrolytes, CBC, and urinalysis. Serum specimens will be analyzed at a central laboratory. Bedside urinary tract infection (IJTI) screens will be accomplished with a portable photometric urine analyzer and an ultrasound of the urinary bladder for post-void residual volume using a BladderScan BVT3000. Medication risk based on the duration and number of medications will be used to develop summary measures of delirium risk in consultation with a clinical Pharm D consultant. Total body water (TBW) will be estimated at the bedside with a multi-frequency Bioelectric Impedance Analysis (BIA) device. The ultimate goal is to provide accurate risk measures and which will lead to the development of effective delirium intervention strategies specifically designed for the LTC population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DELIRIUM, RISK AND RECOVERY RELATION TO COGNITIVE DECLINE Principal Investigator & Institution: Levkoff, Sue; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: (provided by the applicant) Between 32 and 50 percent of elderly patients undergoing cardiac surgery experience symptoms of delirium post surgery (Hammeke & Hastings, 1988; Smith & Dimsdale, 1989). Further, a sizable proportion of coronary artery bypass graft (CABG) surgery patients (between 25 and 80 percent) show some cognitive decline at one year (McKhann et al., 1997a). Delirium may be a key precipitant of long-term cognitive decline in elderly cardiac surgery patients, but few outcome studies have examined this potential link. This information is needed before interventions can be developed to improve long-term cognitive outcomes in elderly cardiac surgery patients. In the proposed Intervention Development Study (IDS), we will perform a prospective cohort study in older patients undergoing CABG surgery to determine the incidence and duration of post-operative delirium, the incidence of longterm cognitive decline, and the relationship between the two. We will also determine the time course of several potential biochemical markers (serum anticholingeric activity and serum amino acid levels, specifically phenylalanine/large neutral amino acid and

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tryptophan/large amino acid ratios) and their relationship to delirium. Risk factors will be measured at pre-surgery baseline, intraoperatively, and at one, six, and twelve months post-operatively to identify factors that put individuals at risk for delirium, and given delirium, risk factors associated with long-term cognitive decline. This project will facilitate the development of an intervention trial to prevent or abate delirium in high-risk CABG patients and to improve post-CABG cognitive outcomes whether or not delirium is confirmed to be a risk factor for cognitive decline. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTIVENESS OF DELIRIUM PREVENTION IN ELDERLY PATIENTS Principal Investigator & Institution: Inouye, Sharon K.; Associate Professor; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2003; Project Start 10-AUG-1995; Project End 30-JUN-2005 Summary: (Applicant's Abstract): Delirium is a common, serious, and potentially preventable problem for hospitalized older patients, with occurrence rates of 25-60 percent, hospital mortality rates of 25-33 percent, and annual Medicare expenditures of over $4 billion (1994). Our previous study, the Delirium Prevention Trial, documented the effectiveness of a multi-component targeted intervention strategy for substantially reducing the risk of developing delirium during hospitalization, compared with usual care. The overall objectives of the current renewal application are to extend the analyses to examine cost-effectiveness, secondary and long-term outcomes, and effects of adherence on intervention effectiveness. These investigations will more fully establish the effectiveness of our intervention strategy, including its overall cost-effectiveness and the lasting nature of the benefits. The proposed study will involve the 852 subjects enrolled into the Delirium Prevention Trial, consisting of 426 matched pairs of intervention and usual care subjects. For the current proposal, we will supplement the data collected during the clinical trial, with one year of follow-up data from: 1) telephone interviews; 2) medical record reviews; 3) health care utilization and charge data from Medicare; 4) Connecticut Long-Term Care Registry; 5) hospital costs from the Hospital Information System; and 6) National Death Index. Using these data sources, cost-effectiveness ratios for the intervention vs. usual care groups will be estimated, using standard and multivariable approaches. The impact of the intervention on secondary and long-term outcomes (e.g., functional and cognitive status, depression, self-rated health, mortality, nursing home placement, and health care utilization) will be examined using standard and longitudinal repeated measures methods. Finally, the impact of adherence on intervention effectiveness will be estimated using bivariate and multivariable approaches. Strengths of the proposed project include the considerable progress and preliminary work, the innovative nature of the intervention strategy and of the analytic approaches in this matched clinical trial, the expertise and experience of the analytic team, and the supportive research environment. This study is highly significant for the promise it holds for demonstrating the effectiveness and costeffectiveness of the Delirium Prevention Trial strategy, which may ultimately yield substantial health and quality of life benefits for the geriatric population at large. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BLOCKADE

ELDER

SURGERY-FUNCTIONAL

RECOVERY

AFTER

BETA

Principal Investigator & Institution: Silverstein, Jeffrey H.; Associate Professor; Anesthesiology; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The ultimate objective of this work is to understand the major determinants of postoperative outcomes and to develop therapeutic modalities and practice parameters that maximize the rate, magnitude and quality of postoperative functional recovery in elderly surgical patients. The immediate objective is to evaluate the impact of anesthetic-coupled intra-operative beta-blockade on long term functional recovery in elders undergoing elective major abdominal surgery. The proposed research is a five-year randomized partial open-label trial of approximately 1100 patients 65 years of age or older having elective major abdominal surgery. Eligible patients will be divided into two groups: those currently receiving chronic betablockade or possessing risk factors for myocardial ischemia will be assigned to receive beta-blockers before and after surgery, those without risk factors will not. Within each group, eligible patients will be randomized to receive either a control anesthetic or anesthetic-coupled intra-operative beta-blockade. Patients will be evaluated preoperatively and postoperatively using a broad battery of functional and performance measures. Postoperative evaluations will take place over three stages: Stage 1 - end of surgery to discharge from the Post-Anesthesia Care Unit; Stage 2 - end of PACU stay through postoperative day three; and Stage 3 - postoperatively at one, three, and six weeks and three and six months. The impact of the intra-operative intervention will be assessed by pursuing the following specific aims: 1) comparison of the time course and extent of long-term (stage 3) functional recovery in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen; 2) comparison of the course of early (stage 1 and 2) recovery with particular reference to postoperative pain and analgesic medications in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen, and; 3) evaluation of the correlation between cardiac troponin release and cardiovascular outcome for six months following operation in elderly surgical patients receiving either a control or an anesthetic-coupled betablockade regimen. Primary outcomes measures will include: 1) Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) (Stage 3 recovery); 2) time to discharge from the Post Anesthesia Care Unit; 3) analgesic requirements self-reported pain by visual analogue scale; 4) incidence of delirium (confusion Assessment Method) (Stage 2 recovery); and 5) troponin I levels (Stage 1 and 2 recovery). The proposed trial leverages recent new data on the natural history of postoperative functional recovery in elders after abdominal surgery with pilot data suggesting that beta-blockade have beneficial effects on functional recovery to support the conduct of a randomized trial of an anesthetic intervention designed to improve short and long-term functional recovery in elders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF DEMENTIA IN OLDER DIALYSIS PATIENTS Principal Investigator & Institution: Murray, Anne M.; Minneapolis Medical Research Fdn, Inc. 600 Hfa Bldg Minneapolis, Mn 55404 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008

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Summary: (provided by applicant): Candidate: Anne Murray, M.D., M.Sc., is a fellowship-trained geriatrician with a Masters in Epidemiology and a staff physician at Hennepin County Medical Center, a teaching hospital affiliated with the University of Minnesota. She is also an investigator with Nephrology Analytical Services, an epidemiology laboratory and repository for the NIH's United States Renal Data System (USRDS) database. Dr. Murray's immediate goal is to pursue research in the epidemiology and prevention of cognitive impairment in dialysis patients. Career Objectives: Dr. Murray's immediate career objectives include: 1) advanced coursework in neuropsychology, study design, longitudinal analysis, and ethical conduct of research, 2) work with her mentors to further develop her research skills in the area of cognitive impairment in renal disease through regularly scheduled meetings and directed readings, 3) conduct a three-year longitudinal study of the prevalence and progression of cognitive impairment in dialysis patients under the guidance of her mentors, 4) continue to conduct analyses on the epidemiology of dementia in dialysis patients using the USRDS database, and 5) during the last year of the award, develop a proposal to obtain funding for a prospective study of the incidence of and risk factors for cognitive impairment in patients with chronic kidney disease, formerly called chronic renal insufficiency. Dr. Murray's long-term career objective is to attain independence as an investigator in the area of epidemiology of cognitive impairment in renal disease and other chronic diseases. Research Plan: During the five-year award period, Dr. Murray plans to use findings from analyses of her pilot data and the USRDS database to conduct a prospective longitudinal study of the prevalence and progression of cognitive impairment in dialysis patients in the Twin Cities. The study will test the hypotheses that 1) dialysis patients have a higher prevalence of cognitive impairment than the general population, 2) the risk of cognitive impairment increases with duration in years of dialysis, and 3) age, Modified Mini-Mental State Examination (3MS) score at baseline, education, and history of stroke will be strong predictors of the rate of progression of cognitive impairment in dialysis patients. Subsequently, Dr. Murray plans to collaborate with her mentors to write a major proposal to examine the epidemiology of cognitive impairment in patients with chronic kidney disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FOCUS Principal Investigator & Institution: Carson, Jeffrey L.; Richard C. Reynolds Professor of Medicin; Medicine; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088545635 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant); Red blood cell transfusions are an extremely common medical intervention in both the United States and worldwide; over 11 million units are transfused in the United States. Between 60% and 70% of all blood is transfused in the surgical setting. Despite the common use of red blood cell transfusions, the threshold for transfusion has not been adequately evaluated and is very controversial. A decade ago the standard of care was to administer a peri-operative transfusion whenever the hemoglobin (Hgb) level fell below 10 g/dl (the "10/30 rule"). Concerns about the safety of blood, especially with respect to HIV and hepatitis, and the absence of data to support a 10 g/dl threshold led to current standard of care today to administer blood transfusions based on the presence of symptoms and not a specific Hgb/hematocrit level. However, there are no randomized clinical trials in surgical patients that have tested the efficacy and safety of withholding blood until the patient develops symptoms or the "10/30" approach to transfusion. Patients with underlying

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cardiovascular disease are at greatest risk of adverse effects from reduced Hgb levels. We propose to conduct a multi-center randomized trial to test if a more aggressive transfusion strategy that maintains postoperative Hgb levels above 10 g/dl improves patient outcome as compared to a more conservative strategy that withholds blood transfusion until the patient develops symptoms of anemia. Eligible patients for the trial will have undergone surgical repair for a hip fracture and have a postoperative Hgb level below 10 g/dl within three days of surgery. Only patients with cardiovascular disease will be entered into the study. Patients will be randomized to one of the two transfusion strategies. The 10 g/dl threshold strategy will use enough red blood cell units to maintain Hgb levels at or above 10 g/dl through hospital discharge. Symptomatic transfusion strategy patients will receive red blood cell transfusions for symptoms of anemia, although transfusion is also permitted but not required if the Hgb level falls below 8 g/dl. Outcomes will include functional recovery (primary outcome: ability to walk ten feet across a room without human assistance at 60-days postrandomization), long-term survival, nursing home placement, and postoperative complications (death in hospital or within 30 days, pneumonia, myocardial infarction, thromboembolism, stroke, delirium). We will randomize 2,600 patients from 25 centers over a 3.5-year period. This will allow us to detect a 16% relative risk reduction in the loss of ability to walk independently with power about 0.90. A pilot study in 84 patients demonstrated the feasibility of the study. Ambulation at 60 days is known to be highly predictive of ultimate functional outcome as well as of mortality at one year. Because inability to walk again has such important implications for quality office, and because, unfortunately, it is a common problem, it far outweighs the remote chance of viral infection or other complications from transfusion in these elderly patients. Also, this study will measure the frequency and 95% confidence intervals of the medical errors that are important in this patient population and are poorly documented in the literature. The medical errors that will be measured are: transfusion errors (blood transfusion to the wrong patient, mislabeling of samples for type and cross match, use of whole blood instead of packed red cells), failure to use thromboembolism prophylaxis, incorrect antibiotic prophylaxis, wrong site surgery and femoral shaft fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GHB: EFFECTS, WITHDRAWAL AND TREATMENT Principal Investigator & Institution: Miotto, Karen A.; Associate Clinical Professor; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Career Goals: The candidate is a psychiatrist whose goal is to expand her research and academic activities in the field of addiction medicine. Her immediate career goal is to obtain the training and experience necessary for becoming an independent investigator. Her professional goal is to become an academic resource in the field of addiction with a focus on evaluation of medications. Research Career Development Plan: The candidate proposes to obtain a Master of Science (M.S.) in Clinical Research Design and Statistical Analysis (CRDSA) from the University of Michigan School of Public Health. This program is designed specifically for physicians and other health care professionals involved in clinical research. In addition to this coursework, the applicant's career development plan draws on the resources of a large, well established addiction research group, the Integrated Substance Abuse Program (ISAP) at UCLA, and includes a program of supervision by experts in their respective fields in the qualitative and quantitative aspects of study design and methodology.

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Description of the research projects: The proposed research plan is designed to objectively describe signs and symptoms of GHB withdrawal, identify predictors of withdrawal severity and treatment response, and develop and validate treatment guidelines for GHB withdrawal. There has been a sharp rise in the number of GHB related emergency room visits in the United States over the past few years, yet little is known about effective treatment of GHB withdrawal and dependence. The signs and symptoms of GHB withdrawal begin one to six hours after last use, and may escalate rapidly and unpredictably to delirium, agitation, and psychosis. Given the rapid, progressive and serious nature of GHB withdrawal symptoms, there is a crucial need to develop improved treatments. There has been little systematic study of the signs and symptoms of withdrawal, and controlled studies on the effectiveness of treatment of these symptoms are lacking. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HARVARD OLDER AMERICANS INDEPENDENCE CENTER Principal Investigator & Institution: Lipsitz, Lewis A.; Professor of Medicine; Divison on Aging; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-MAR-1990; Project End 30-JUN-2006 Summary: (provided by the applicant) This application requests renewal of our previously successful Harvard Older American's Independence Center (OAIC), but represents an exciting new direction with new leadership, new investigators committed to gerontologic research, and a new series of intervention development studies focussed on the development of interventions to overcome common, disabling, but underinvestigated geriatric conditions that threaten the independence of older Americans. Dr. Lewis A. Lipsitz, Professor of Medicine and founding member of the Harvard OAIC will serve as principal investigator. The Harvard OAIC aims to prevent and ameliorate cognitive and functional disability in elderly patients through the conduct of translational gerontologic research, the development of new investigators skilled in gerontologic research, and the dissemination of information about research findings that can maximize the independence of elderly people. This effort represents a major, multi-institutional, multidisciplinary collaboration among faculty from Harvard's Division on Aging and affiliated clinical and academic institutions. This proposal builds upon the previous accomplishments, infrastructure, and collaborative relationships of the Harvard OAIC. It includes 3 intervention development studies (Noise-Enhanced Sensorimotor Function in Aging and Disease, by James Collins, PhD; Cardiovascular Risk and Frontal Dysfunction in Black Elders, by William Milberg, PhD; and Delirium Risk Recovery and Relation to Cognitive Decline. by Sue Levkoff, SiD and Edward Marcantonio, MD); a Research Development Core led by Douglas Kiel, MD, David Calkins, MD, and Kenneth Minaker, MD; 3 Research Resources Cores (Subject Recruitment Core, led by Roberta Rosenberg, MEd and Lewis Lipsitz, MD; Bioengineering/Basic Science Core, led by Jeff Hausdorff, PhD; and an Evaluation/Biostatistics Core, led by Janice Weinberg, ScD); a Demonstration and Information Dissemination Project led by Roberta Rosenberg, MEd and Sue Levkoff, ScD; and a Leadership and Administration Core led by Lewis Lipsitz, MD. Harvard's commitment to the future of its Division on Aging, its strong basic and clinical research programs, a talented faculty, outstanding academic resources, and well-established relationships with Boston's multiethnic communities, will all help assure the success of this program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HHV-6 TRANSPLANT

AND

CNS

DISEASE

FOLLOWING

STEM

CELL

Principal Investigator & Institution: Zerr, Danielle M.; Children's Hospital and Reg Medical Ctr Box 5371, 4800 Sand Point Way Ne, Ms 6D-1 Seattle, Wa 98105 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2009 Summary: (provided by applicant): There are compelling data linking human herpesvirus 6 (HHV-6) reactivation and serious central nervous system (CNS) dysfunction including encephalitis and seizures following hematopoietic stem cell transplant (HSCT). Despite appropriate therapy, HHV-6 CNS dysfunction is associated with high mortality and morbidity. While antiviral therapy may abrogate viremia and detectable levels of virus in CSF, the toxicity of the drugs of choice, ganciclovir and foscamet, are high and the clinical effects of such therapy uncertain. Preemptive or prophylactic approaches may result in better clinical outcomes, but before such approaches can be tested, the spectrum, incidence, and outcomes of HHV-6 CNS dysfunction following HSCT as well as its risk factors need to be defined. Our preliminary data from a prospective pilot study of delirium after HSCT suggests an association between HHV-6 and CNS dysfunction. Also, a summary of patients with HHV-6 encephalitis from our center suggests that there may be lasting neurological sequelae in the majority of survivors. Thus, we hypothesize that HHV-6 reactivation after HSCT is associated with a larger spectrum of CNS dysfunction than currently recognized and that this leads to persistent, severe cognitive abnormalities. Aim 1. To evaluate the association between HHV-6 reactivation and CNS dysfunction and to define the spectrum and incidence of CNS dysfunction preceded by HHV-6 reactivation. Aim 2. To define the long-term outcomes of HHV-6 associated CNS dysfunction following HSCT. We propose a large prospective study of HSCT recipients. Patients' plasma will be screened twice weekly for HHV-6 using a real-time quantitative fluorescent-probe polymerase chain reaction (PCR) assay. All CSF specimens obtained for routine or urgent purposes will also be tested for HHV-6. Patients will be screened three times weekly for CNS dysfunction using validated neuropsychiatric instruments that have been used successfully in HSCT recipients. Neuropsychological testing will be performed at three time points during the study to define short- and long-term cognitive sequelae associated with HHV-6 CNS dysfunction. Data from this project will not only inform current diagnosis of and prognosis for HHV-6 CNS dysfunction, but will also be used to design an intervention trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTAL HEALTH AND NURSE STAFFING IN US NURSING HOMES Principal Investigator & Institution: Myers, Sarah K.; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Using 1998 data, we have estimated persons with mental disorders in U.S. nursing homes may now total approximately 1,000,000, or 67% of all residents. Jakubiak and Callahan (1995-96) note that, "More than two-thirds of nursing home residents exhibit some level of dementia, depression, anxiety, schizophrenia, or delirium." High quality, error free nursing home care is time and labor-intensive and vital to optimizing residents' mental and physical health, but the current nursing shortage will escalate as the Baby Boomers age and require substantially more care. In the proposed project, we will examine possible associations between nurse

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staffing and mental health outcomes in approximately 17,000 U.S. nursing homes. We will focus on two outcomes available in the Center for Medicare and Medicaid Services' On-line Survey Certification of Automated Records: (1) Psychoactive medication use; and (2) Deficiencies for mental health care. Mental disorders are quite prevalent in nursing homes and present a substantial illness burden. Additionally, quality issues around inappropriate use of chemical restraints, inappropriate treatment, and failure to diagnose mental disorders are errors that generate concern among nursing home residents, their families, nursing home staff, and the public. The insights possible through this research support a key component of NIMH's research plan to: "Determine the best fit and utility of treatment and prevention interventions for diverse populations," including the elderly population and to: "Determine the impact of organization and financing of services on outcomes." The specific objectives are to: (1) Describe nursing staffing levels in U.S. nursing homes; (2) describe the mix of nursing staff in U.S. nursing homes; (3) assess possible associations between nursing home staffing and mental health-related quality outcomes and deficiencies (including those persisting over time); (4) assess possible associations between nursing home staff mix and mental health-related quality outcomes and deficiencies (including those persisting overtime); and (5) inform policies related to nurse staffing that aim to enhance mental health outcomes. We will generate simple descriptive statistics related to the level and mix of nursing staff, mental health-related quality outcomes and deficiencies, and basic environmental and market characteristics for each nursing home. Then, we will examine the cross-sectional relationship between (1) mental health-related quality outcomes and deficiencies and (2) facility and market factors (especially nurse staffing levels and mix). Because studies of small area variation show that environmental factors have a strong impact upon the health care system and can affect process and outcome variables such as psychotropic medication use and code violations, we will include them in our analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: METHODOLOGY DEVELOPMENT FOR LONGITUDINAL STUDIES OF PRECIPITATING EVENTS Principal Investigator & Institution: Dubin, Joel A.; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2003 Summary: (provided by applicant): The study of precipitating events is central to the understanding of geriatric syndromes such as delirium, falls, and functional decline. As longitudinal studies are increasingly used to identify and understand the mechanism of precipitating events, several methodological issues must be addressed. First, there is the potential for data collected at the time of an observed precipitating event to add important information to data collected at regularly scheduled fixed time intervals. However, it is uncertain how to best model these "triggered" data without introducing bias and whether these data provide additional explanatory information. Second, the study of precipitating events typically assumes a one-way relationship between the event and the outcome of interest. However, the possibility of a feedback loop exists, such that the outcome may be a risk factor for the precipitating event which may lead to a future outcome and so on. These methodological issues are also highly relevant to the study of patients' treatment preferences. This proposal will make use of an existing longitudinal database examining the relationship between changes in older persons' functional status (the precipitating event) and changes in their treatment preferences (the outcome) to examine these issues. The results of this study will help researchers

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better design (and analyze and interpret data from) future longitudinal studies examining the relationship of precipitating events to a wide variety of multifactorial geriatric syndromes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR BASIS OF POSTOPERATIVE DELIRIUM IN THE ELDERLY Principal Investigator & Institution: Kwatra, Madan M.; Associate Professor; Anesthesiology; Duke University Durham, Nc 27710 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): Postoperative delirium is a frequent complication in the elderly, with an incidence rate ranging from 10% to 70%. It is associated with several adverse outcomes, including prolonged hospitalizations, poor functional recovery, and in some cases increased mortality. Because the proportion of elderly surgical patients is increasing, it is critical to understand the pathophysiology of postoperative delirium. Several neurotransmitter systems appear to be involved in delirium, and the proposed studies will test the hypothesis that postoperative delirium is associated with changes in the expression of specific genes and proteins Identification of these genes and proteins will lead to novel strategies for diagnosing, treating, and possibly preventing postoperative delirium. The first aim will be to examine changes in gene expression in peripheral blood mononuclear cells (PBMCs) using DNA microarrays. This aim is based on our preliminary data indicating that surgery causes a twofold or greater change in the expression of 466 genes in PBMCs, with 329 getting up-regulated and 137 getting down-regulated. The magnitude of this surgery-inducing change in gene expression is unprecedented and raises the probability that some of these genes are the markers of and/or the cause of postoperative delirium. We will enroll 250 elderly patients (>65 years old) undergoing hip or knee replacement-a procedure that causes about 20% incidence of postoperative delirium-and assess postoperative delirium using a battery of instruments. Gene expression in pro- and post-surgery PBMCs from 50 delirious and 50 non-deledous patients will be determined using a DNA microarray chip containing 12,000 human genes. Statistical analysis of the gene expression data will identify the cluster of genes associated with postoperative delirium. The second specific aim will be to identify serum proteins that change with delirium by examining global protein expression using 2D-gel electrophoresis/mass spectrometry. The PI and the co-PI have assembled an interdisciplinary team with expertise in anesthesiology, bioinformatics, geriatrics, molecular pharmacology, nursing, psychiatry, psychology, orthopedic surgery, and statistics. In addition, consultants are available with expertise in delirium, DNA microarrays, and mass spectrometry. Our team is therefore in a unique position to successfully complete the proposed studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NIA DEVELOPMENT AWARD PAIN AND DELIRIUM IN HIP FRACTURE Principal Investigator & Institution: Morrison, Sean; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: Dr. Morrison's interest in quality of life issues at the end-of-life has led him to focus on palliative care and geriatrics. Merging these two areas, his clinical and research work suggest that pain symptoms tend to be overlooked in patients presenting with

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dementia/delirium. Dr. Morrison's long-term objectives are to promote understanding of this issue and to enhance the quality of life of older patients through improved pain and symptom management. The overall objective of the research project is to examine the management of pain in hip fracture patients and the inter-related problem of delirium. The specific aims are to: determine the incidence and prevalence of pain and delirium in patients with hip fracture; describe the management of pain and delirium; identify risk factors for the development of delirium and for inadequate pain management; examine the relationship between delirium and pain on select patient outcome variables; and develop strategies and interventions to improve the management of delirium and pain. Patients entering the Mount Sinai Health System presenting with a hip fracture will be studied. All patients will be assessed daily through the fifth hospital or third full post-operative day and thereafter every other day through the ninth hospital day for the severity of their pain and for delirium. Information will be collected on specific processes of care that are used during the treatment course of these patients with particular attention to those processes that could lead to the development of pain or delirium and those directed at the management of these two conditions by concurrently following the course of the patients and by reviewing medical records. Patients will be followed longitudinally through their hospitalization and at 2 and 6 months with assessments of pain, functional status, morbidity, and mortality. In the final half of the five year project, the data collected from the initial phase of this proposal will be used to plan and test two interventions at the Mount Sinai Hospital. The first intervention will be directed at improving pain management. The second intervention will be randomized controlled trial evaluating the pharmacologic management of delirium. Dr. Morrison will engage in a number of educational activities in order to enhance his research and statistical analysis skills. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OUTCOMES OF DELIRIUM IN THE ELDERLY Principal Investigator & Institution: Foreman, Marquis D.; Professor; Medical-Surgical Nursing; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by the applicant) Delirium is a common disorder affecting as many as 80 percent of older hospitalized patients. Despite the fact that at least 30 percent of delirious patients continue to manifest symptoms at the time of discharge from the hospital, little investigation of delirium has occurred outside of acute care settings. The health outcomes directly attributable to delirium, the utilization of health care resources, the costs of care, the effects of continued care on delirium, and the actual course of delirium remain largely W1known. A prospective, longitudinal, cohort design with 10 years of follow-up is proposed; the work described here covers the first five years of study and reflects the first 3 years of follow-up. The specific aims are to: (1) evaluate the long-term effects of delirium on selected health outcomes, specifically, functional and cognitive status, mortality, utilization of health care resources, and the costs of care; (2) document the effect of continued care (e.g., institutionalization, rehabilitation, and home care) on the severity, duration, and recurrence of delirium; and (3) describe the natural course of delirium beyond an episode of hospitalization. Elderly subjects hospitalized for greater than 48 hours will be followed during their hospitalization. Eighty-six delirious subjects and 86 randomly selected non-delirious subjects will be followed at 1 week and 1, 2, 3, 6, 9, 12, 18, 24, 30, and 36 months after discharge. Major variables include cognition (Mini-Mental State Exam. Digit Span, modified Blessed Dementia Rating Scale), delirium (Confusion Assessment Method,

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NEECHAM Confusion Scale. Delirium Rating Scale), physical functional status (Activities of Daily Living, Instrumental Activities of Daily Living), resource utilization (Resource Utilization Inventory, continuing care, Readmission Inventory), and covariates (Charlson Index of Co-morbidity, Geriatric Depression Scale-Short Form). Data will be analyzed using descriptive statistics, repeated measures ANOV A and MANOV A, and survival analysis. Results of this study will establish a better understanding of the natural history of delirium, its long-term consequences, and the effects of continued care on delirium by which to design efficacious and cost-effective interventions to prevent or treat delirium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHARMACIST TECHNOLOGY FOR NURSING HOME RESIDENT SAFETY? Principal Investigator & Institution: Lapane, Kate L.; Co-Director, Sage Study Group; Center for Gerontology and Health Care Research; Brown University Box 1929 Providence, Ri 02912 Timing: Fiscal Year 2003; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: Verbatim from the Applicant?s Abstract In nursing homes, the average resident uses six different medications and 20 percent use at least 10 different medications. Given the medical complexity of nursing home residents, the use of multiple medications may be clinically appropriate. Yet, changes in pharmacokinetics and pharmacodynamics make older persons more vulnerable to adverse medication effects, placing them at increased risk for adverse drug events (ADEs). Gurwitz et al deemed 1.39 ADEs per 100 resident months as fatal, life-threatening, or serious. Of preventable ADEs, 70 percent occurred at the monitoring stage of the medication use process. Indeed, ".patients may be experiencing unnecessary adverse medication reactions as a result of inadequate monitoring of medications" (OIG, 1997). Few patient safety systems use information technology in the monitoring stage. Our application is unique in that we aim to test information technology designed specifically to alert prescribers and nursing facility staff to information that can reduce the threat to patient safety associated with ADEs using a unique clinical tool for health professionals (Geriatric Risk Assessment MDS Med Guide (GRAM)). The GRAM software is intended to assist in the decision-making process of evaluating complex medication regimens of older patients; facilitate incorporation of patient assessment data in the monitoring of medication therapy; and foster inclusion of recommendations in the care plan to prevent avoidable medication-related problems. We propose a large-scale randomized trial. We will recruit 26 nursing homes; half will receive the intervention. Evaluation of the project relies on existing data sources to trigger in-depth chart reviews. We will determine the extent to which the use of the GRAM clinical tool increases the incorporation of monitoring recommendations to detect ADEs into the resident care plan; reduces the incidence of delirium, falls with and without fracture, (the two most common ADEs in LTC) and hospitalizations due to ADEs; reduces the triggering of resident assessment protocol (RAPS) triggers for delirium and falls. We will also quantify the impact of the GRAM software on the efficiency, productivity, workload, and job satisfaction of the consultant pharmacists and nursing facility staff. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHYSICAL RESTRAINTS AND THERAPY DISRUPTION IN HOSPITALS Principal Investigator & Institution: Minnick, Ann F.; Rush University Medical Center Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 31-MAR-2006 Summary: (provided by investigator): Introduction: Numerous adverse consequences (death, fracture, aspiration and delirium) have been reported to be the direct or indirect result of physical restraint (PR). Given PR's serious threat to patient safety, especially that of the elderly, Health Care Finance Administration regulations mandate the restriction of PR use. Although efforts to reduce PR in nursing homes have demonstrated success, the variables associated with hospital PR use have not been identified. Safe PR reduction is of special concern to intensive care unit clinicians because of the real threat to safety posed by patients' premature disruption (e.g. selfextubation) of life sustaining therapies or by falls. Defining the extent and context of PR use and of therapy disruption is hampered by the lack of available national data. Purpose/Aims: This three year prospective study seeks to (1) determine the scope and variation in physical restraint use in non-psychiatric acute care settings, (2) identify the extent to which administratively mediated variables explain PR use variation, and (3) identify the rates, contexts and consequences of therapy disruption for restrained and unrestrained intensive care unit (ICU) patients in the elderly and non-elderly populations. Methods/Design: A three year, prospective unit level study of 40 randomly selected acute care general hospitals in five metropolitan areas (New York, Chicago, Houston, Denver and Phoenix) will include: (A) a PR prevalence and context determination for all non-psychiatric, non-emergency, non-operative, non-long term care units through an 18 randomly selected day observational method (Aim l) (B) an examination of the ability of selected labor, capital and organizational variables to explain PR use on the three highest usage type units (n=120 units). [Highest usage types are those determined in step A]. (Aim 2) (C) a 90 day prospective study of one adult ICU in each hospital (n=40 units) (Aim 3). Descriptive, correlational, and multi-level statistical analyses will be conducted. Health Related Implications: The results will (1) inform public policy debates related to the priority for further PR reduction efforts (2) assist in the development of effective PR reduction efforts through determination of the role of labor, capital and organizational variables (3) provide information regarding the effectiveness of PR in preventing therapy disruption in ICUs where resistance to restraint reduction is based on provider concerns for patient safety, and (4) help determine the extent and sequelae of therapy disruption to allow for later exploration of its effects on the costs and quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SCREENING FOR ANTIVIRALS AGAINST FLAVIVIRUSES Principal Investigator & Institution: Olivo, Paul D.; President & Cso; Apath, Llc St. Louis, Mo 63141 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Viral hemorrhagic fever (VHF) refers to a group of illnesses that are caused by members of four families of viruses. These viruses can cause life-threatening disease with signs of bleeding under the skin, in internal organs, or from various body orifices. Severe cases may also show shock, nervous system malfunction, coma, delirium, seizures and renal failure. Some VHF agents have been suspect for abuse in biowarfare/bioterrorism. Members of the family Flaviviridae are among the

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viral agents that cause VHF. Viruses in this family are all enveloped positive-sense RNA viruses with many similar features in their genome structure and replication cycle. There is no specific treatment for any of the agents that cause VHF, although ribavirin has been effective in treating some cases of VHF and shows some activity against a number of RNA viruses including YFV.This application is in response to the challenge to develop specific treatment modalities for these diseases. We plan to develop cellbased assays for testing and screening of compounds with antiviral activity against certain flaviviruses. These assays will be based on cell lines that harbor a constitutively replicating subgenomic replicon and are modeled on a prototype system developed for hepatitis C virus. Our approach is applicable to a number of viruses that cause viral hemorrhagic fever such as category A bioterrorism agents (tick-borne encephalitis virus, Kyasanur Forest disease virus, Omsk hemorrhagic fever virus, etc.) and category C agents (yellow fever virus, Dengue virus, etc.). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEDATION AND PSYCHOPHARMACOLOGY IN CRITICAL CARE Principal Investigator & Institution: De Wit, Marjolein; Internal Medicine; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Marjolein de Wit, M.D., Assistant Professor of Medicine in the Pulmonary and Critical Care Division at Virginia Commonwealth University, seeks support for this research training in order to establish herself as an independent clinical investigator examining sedation of critically ill patient. Her goal is to evaluate the effectiveness of various sedation strategies, to evaluate the prevalence of psychiatric complications, and to compute the pharmacokinetics of commonly used sedatives. In order to enhance her research skills, Dr. de Wit will enroll in a master's degree program in clinical research and design offered by the institution as well as obtain formal training in pharmacokinetics and pharmacodynamics. Certain methods of sedation increase the duration of respiratory failure. Two strategies, a nursingimplemented sedation algorithm and daily interruption of sedatives, decrease length of mechanical ventilation compared to "conventional care" but have not been compared to each other. The reason certain methods of sedation lead to prolonged respiratory failure is unknown but may be related to altered pharmacokinetics and dynamics that are unique to critically ill patients. Critically ill patients receive substantial doses of sedatives over prolonged periods. The impact of these management strategies on shortand long-term psychiatric complications are unknown. The study proposed in this grant application seeks to test the central hypothesis that sedation practices impact strongly on outcome of respiratory failure and psychiatric complications. The three specific aims are (1) to compare two sedation strategies (protocol directed sedation and daily interruption of sedatives), (2) to examine the prevalence of psychiatric complications, and (3) to compute the pharmacokinetics of commonly used sedatives and narcotics. These aims will be achieved by enrolling critically ill patients in a prospective randomized trial comparing the above mentioned sedation strategies, and assessing sedation level as well as delirium throughout the duration of respiratory failure. Sedative plasma levels will be measured, and pharmacokinetics computed. Psychiatric morbidity will be assessed by administration of validated questionnaires. This study design creates a pathway for new understanding of the impact of sedation and the incidence of morbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRIAL TO REDUCE DELIRIUM IN AGED POST ACUTE PATIENTS Principal Investigator & Institution: Marcantonio, Edward R.; Director of Research; Hebrew Rehabilitation Center for Aged 1200 Centre St, Roslindale Boston, Ma 02131 Timing: Fiscal Year 2002; Project Start 01-MAY-2000; Project End 30-APR-2004 Summary: Common, morbid, and costly, delirium affects one third of hospitalized elders, and plays a central role in the cascade of adverse events that leads to functional decline and loss of independence. Moreover, as acute care stays continue to shorten and evidence mounts that delirium may persist for many weeks, concern about delirium can no longer be confined to the hospital. Preliminary data from our own work and others suggest that 25 percent of elders admitted to post-acute care facilities are delirious, and that two-thirds of these remain delirious one month later. It is our hypothesis that persistent delirium exerts a significant negative influence on functional recovery in post-acute care. To test this, we propose a randomized controlled interventional trial involving 500 subjects admitted with delirium at four post-acute facilities. A Delirium Abatement Program (DAP) will be developed using specialized protocols for: 1) diagnosing delirium, 2) treating common causes of delirium, 3) preventing complications of delirium, and 4) restoring function. The DAP will be implemented at two intervention facilities under the supervision of Drs. Marcantonio and Murphy. Two additional facilities, matched by demographic, facility, and clinical characteristics to the intervention sites, will serve as controls. To assess the effectiveness of the DAP, subjects will undergo blinded assessments of delirium, cognitive, and functional status at intake, weekly while in the post-acute facilities, and at one, three, and six months after admission. Using bivariable, multivariable, and longitudinal analyses, we will assess the impact of the DAP on the prevalence and severity of delirium, and the rate of ADL functional improvement two weeks and one month after post-acute admission. We will also assess the long term impact of our intervention on ADL functional recovery three and six months after post-acute admission. This study will be the first to examine the natural history and impact of persistent delirium in-the post-acute setting. If the DAP is successful in reducing delirium and improving functional recovery, our findings will serve as a model of a targeted approach to improve the care of elders in the post-acute setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “delirium” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for delirium in the PubMed Central database: 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Predisposing factors for delirium in the surgical intensive care unit. by Aldemir M, Ozen S, Kara IH, Sir A, Bac B.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=83853

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Prevalence and detection of delirium in elderly emergency department patients. by Elie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F.; 2000 Oct 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80546

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Preventing Delirium at the End of Life: Lessons From Recent Research. by Greenberg DB.; 2003 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=353038

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Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. by Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ, Laplante J.; 2002 Oct 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=126506

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Treatment of Delirium With Quetiapine. by Schwartz TL, Masand PS.; 2000 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=181102

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with delirium, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “delirium” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for delirium (hyperlinks lead to article summaries): •

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A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery. Author(s): Aizawa K, Kanai T, Saikawa Y, Takabayashi T, Kawano Y, Miyazawa N, Yamamoto T. Source: Surgery Today. 2002; 32(4): 310-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12027195

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A patient with lithium intoxication developing at therapeutic serum lithium levels and persistent delirium after discontinuation of its administration. Author(s): Omata N, Murata T, Omori M, Wada Y. Source: General Hospital Psychiatry. 2003 January-February; 25(1): 53-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12583932

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A pilot trial of quetiapine for the treatment of patients with delirium. Author(s): Pae CU, Lee SJ, Lee CU, Lee C, Paik IH. Source: Human Psychopharmacology. 2004 March; 19(2): 125-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14994323

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A prospective, open-label, flexible-dose study of quetiapine in the treatment of delirium. Author(s): Sasaki Y, Matsuyama T, Inoue S, Sunami T, Inoue T, Denda K, Koyama T. Source: The Journal of Clinical Psychiatry. 2003 November; 64(11): 1316-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14658945

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Acute benzodiazepine withdrawal delirium after a short course of flunitrazepam in an intensive care patient. Author(s): Diehl JL, Guillibert E, Guerot E, Kimounn E, Labrousse J. Source: Annales De Medecine Interne. 2000 April; 151 Suppl A: A44-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10855377

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Acute delirium associated with combined diphenhydramine and linezolid use. Author(s): Serio RN. Source: The Annals of Pharmacotherapy. 2004 January; 38(1): 62-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14742796

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Acute delirium induced by metoprolol. Author(s): Fisher AA, Davis M, Jeffery I. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 2002 March; 16(2): 161-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12090909

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Acute delirium, delusion, and depression during IFN-beta-1a therapy for multiple sclerosis: a case report. Author(s): Goeb JL, Cailleau A, Laine P, Etcharry-Bouyx F, Maugin D, Duverger P, Gohier B, Rannou-Dubas K, Dubas F, Garre JB. Source: Clinical Neuropharmacology. 2003 January-February; 26(1): 5-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12567157

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Acute dementia with delirium due to vitamin B12 deficiency: a case report. Author(s): Lerner V, Kanevsky M. Source: International Journal of Psychiatry in Medicine. 2002; 32(2): 215-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12269601

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Acute postoperative delirium: definitions, incidence, recognition, and interventions. Author(s): O'Brien D. Source: Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses / American Society of Perianesthesia Nurses. 2002 December; 17(6): 384-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476404

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Admission characteristics of trauma patients in whom delirium develops. Author(s): Blondell RD, Powell GE, Dodds HN, Looney SW, Lukan JK. Source: American Journal of Surgery. 2004 March; 187(3): 332-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006560

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Agitated delirium with posterior cerebral artery infarction. Author(s): Vatsavayi V, Malhotra S, Franco K. Source: The Journal of Emergency Medicine. 2003 April; 24(3): 263-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12676294

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Agitated terminal delirium and association with partial opioid substitution and hydration. Author(s): Morita T, Tei Y, Inoue S. Source: Journal of Palliative Medicine. 2003 August; 6(4): 557-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14516497

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Amiodarone-induced delirium. Author(s): Athwal H, Murphy G Jr, Chun S. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 November-December; 11(6): 696-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14609814

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An empirical study of different diagnostic criteria for delirium among elderly medical inpatients. Author(s): Cole MG, Dendukuri N, McCusker J, Han L. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Spring; 15(2): 200-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724462

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An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Author(s): Breitbart W, Tremblay A, Gibson C. Source: Psychosomatics. 2002 May-June; 43(3): 175-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12075032

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An unusual case of spontaneous and remitting functional decline in an elderly man: is "functional delirium" a clinical entity? Author(s): Guerini F, Bellwald C, Metitieri T, Bellelli G. Source: Aging Clin Exp Res. 2002 June; 14(3): 221-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12387532

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Are we ready to monitor for delirium in the intensive care unit? Author(s): Tanios MA, Epstein SK, Teres D. Source: Critical Care Medicine. 2004 January; 32(1): 295-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707599

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Assessing for delirium. Author(s): Schofield I. Source: Nursing Older People. 2002 October; 14(7): 31-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12382563

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Barbiturate delirium. Author(s): Gibson II. Source: The Practitioner. 1966 September; 197(179): 345-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5916201

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Bedside cognitive examination. Usefulness in detecting delirium and dementia. Author(s): Roca RP. Source: Psychosomatics. 1987 February; 28(2): 71-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3432526

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Behavioral and pharmacologic treatment of delirium. Author(s): Jacobson S, Schreibman B. Source: American Family Physician. 1997 November 15; 56(8): 2005-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9390096

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Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders. Author(s): Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM. Source: Archives of Neurology. 1989 June; 46(6): 696-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2730383

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Benzodiazepine-induced and anticholinergic-induced delirium in the elderly. Author(s): Tune LE, Bylsma FW. Source: Int Psychogeriatr. 1991 Winter; 3(2): 397-408. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1687445

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Beta-endorphin, cortisol and postoperative delirium: a preliminary report. Author(s): McIntosh TK, Bush HL, Yeston NS, Grasberger R, Palter M, Aun F, Egdahl RH. Source: Psychoneuroendocrinology. 1985; 10(3): 303-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2932761

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Beware of bismuth: post maxillectomy delirium. Author(s): Harris RA, Poole A. Source: Anz Journal of Surgery. 2002 November; 72(11): 846-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12437701

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Biochemical investigations into the alcoholic delirium: alterations of biogenic amines. Author(s): Athen D, Beckmann H, Ackenheil M, Markianos M. Source: Arch Psychiatr Nervenkr. 1977 October 11; 224(2): 129-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=921518

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Brain magnetic resonance imaging findings in ECT-induced delirium. Author(s): Figiel GS, Coffey CE, Djang WT, Hoffman G Jr, Doraiswamy PM. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 1990 Winter; 2(1): 53-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2136061

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Bupropion and delirium. Author(s): Liberzon I, Dequardo JR, Silk KR. Source: The American Journal of Psychiatry. 1990 December; 147(12): 1689-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2123081

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Can delirium relieve psychosis? Author(s): Malur C, Fink M, Francis A. Source: Comprehensive Psychiatry. 2000 November-December; 41(6): 450-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11086151

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Caring for older people with a delirium. Author(s): Doyle C. Source: Nursing Older People. 2001 July; 13(5): 37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12008620

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Celecoxib- and rofecoxib-induced delirium. Author(s): Macknight C, Rojas-Fernandez CH. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2001 Spring; 13(2): 305-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11449042

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Change diagnosis to "alcohol withdrawal delirium"? Author(s): Rosenbaum M. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1357-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832261

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Changing clinical practice through research: the case of delirium. Author(s): Lacko L, Bryan Y, Dellasega C, Salerno F. Source: Clinical Nursing Research. 1999 August; 8(3): 235-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10887873

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Characteristics associated with delirium persistence among newly admitted postacute facility patients. Author(s): Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2004 April; 59(4): 344-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071077

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Chronic delirium treated by daily dialysis in a patient suffering from chronic renal failure. Author(s): Modai I, Stoler M, Valevski A. Source: The Journal of Nervous and Mental Disease. 1993 June; 181(6): 394-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8501462

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Clinical and ethical questions concerning delirium study on patients with advanced cancer. Author(s): Davis MP, Walsh D. Source: Archives of Internal Medicine. 2001 January 22; 161(2): 296-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11176754

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Clinical signs of ICU syndrome/delirium: an observational study. Author(s): Granberg-Axell A, Bergbom I, Lundberg D. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2001 April; 17(2): 72-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11817445

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Clinical utility and validation of the Japanese version of Memorial Delirium Assessment Scale in a psychogeriatric inpatient setting. Author(s): Matsuoka Y, Miyake Y, Arakaki H, Tanaka K, Saeki T, Yamawaki S. Source: General Hospital Psychiatry. 2001 January-February; 23(1): 36-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11226556

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Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: Assessing delirium in advanced cancer. Author(s): Lawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED. Source: Cancer. 2000 June 15; 88(12): 2859-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10870073

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Cocaine-excited delirium and severe acidosis. Author(s): Allam S, Noble JS. Source: Anaesthesia. 2001 April; 56(4): 385-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11284850

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Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study. Author(s): Morita T, Tsunoda J, Inoue S, Chihara S, Oka K. Source: Palliative Medicine. 2001 May; 15(3): 197-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11407191

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Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? Author(s): Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Source: International Journal of Geriatric Psychiatry. 2002 December; 17(12): 1112-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12461759

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Confusion/delirium following cataract surgery: an incidence study of 1-year duration. Author(s): Milstein A, Pollack A, Kleinman G, Barak Y. Source: Int Psychogeriatr. 2002 September; 14(3): 301-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12475090

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Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. Author(s): Fick D, Foreman M. Source: Journal of Gerontological Nursing. 2000 January; 26(1): 30-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10776167

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Costs associated with delirium in mechanically ventilated patients. Author(s): Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW. Source: Critical Care Medicine. 2004 April; 32(4): 955-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071384

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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. Author(s): Ely EW, Stephens RK, Jackson JC, Thomason JW, Truman B, Gordon S, Dittus RS, Bernard GR. Source: Critical Care Medicine. 2004 January; 32(1): 106-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707567

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Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications? Author(s): Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Source: International Journal of Geriatric Psychiatry. 2004 March; 19(3): 271-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15027043

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Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Author(s): Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Source: Jama : the Journal of the American Medical Association. 2004 April 14; 291(14): 1753-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082703

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Delirium from valproic acid with lamotrigine. Author(s): Mueller TH, Beeber AR. Source: The American Journal of Psychiatry. 2004 June; 161(6): 1128-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15169707

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Delirium in elderly patients. Author(s): Cole MG. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2004 January-February; 12(1): 7-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729554

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Delirium in the first days of acute stroke. Author(s): Caeiro L, Ferro JM, Albuquerque R, Figueira ML. Source: Journal of Neurology. 2004 February; 251(2): 171-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14991351

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Delirium in the terminally ill. Author(s): Cochrane Database Syst Rev. 2001;(1):CD000395 Source: Clinics in Geriatric Medicine. 2000 May; 16(2): 357-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279689

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Delirium induced by abrupt discontinuation of paroxetine. Author(s): Hayakawa Y, Sekine A, Shimizu T. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2004 Winter; 16(1): 119-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14990771

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Delirium is independently associated with poor functional recovery after hip fracture. Author(s): Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Source: Journal of the American Geriatrics Society. 2000 June; 48(6): 618-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10855596

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Delirium symptoms and low dietary intake in older inpatients are independent predictors of institutionalization: a 1-year prospective population-based study. Author(s): Bourdel-Marchasson I, Vincent S, Germain C, Salles N, Jenn J, Rasoamanarivo E, Emeriau JP, Rainfray M, Richard-Harston S. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2004 April; 59(4): 350-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071078

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Delirium. Author(s): Burns A, Gallagley A, Byrne J. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2004 March; 75(3): 362-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14966146

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Delirium: a call to improve current standards of care. Author(s): Flaherty JH, Morley JE. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2004 April; 59(4): 341-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071076

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Delirium--the cost of inattention. Author(s): Bowton DL. Source: Critical Care Medicine. 2004 April; 32(4): 1080-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071410

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Detecting and preventing dementia. but what about delirium? Author(s): Newman BY. Source: Optometry. 2003 November; 74(11): 689-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14653657

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Detection and documentation of dementia and delirium in acute geriatric wards. Author(s): Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Source: General Hospital Psychiatry. 2004 January-February; 26(1): 31-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757300

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Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Author(s): Sikich N, Lerman J. Source: Anesthesiology. 2004 May; 100(5): 1138-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114210

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Development of delirium: a prospective cohort study in a community hospital. Author(s): Martin NJ, Stones MJ, Young JE, Bedard M. Source: Int Psychogeriatr. 2000 March; 12(1): 117-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10798458

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Differentiating the three D's: delirium, dementia, and depression. Author(s): Edwards N. Source: Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. 2003 December; 12(6): 347-57; Quiz 358. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725146

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Does delirium increase hospital stay? Author(s): McCusker J, Cole MG, Dendukuri N, Belzile E. Source: Journal of the American Geriatrics Society. 2003 November; 51(11): 1539-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687382

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Donepezil in advanced dementia, or delirium? Author(s): Palmer TR. Source: Journal of the American Medical Directors Association. 2004 January-February; 5(1): 67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726803

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Drug-induced delirium. Author(s): Brown TM. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 113-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837100

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Early detection of postoperative delirium and confusion in a surgical ward using the NEECHAM confusion scale. Author(s): Matsushita T, Matsushima E, Maruyama M. Source: General Hospital Psychiatry. 2004 March-April; 26(2): 158-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15038935

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Early diagnosis of delirium after cardiac surgery. Author(s): Koolhoven I, Tjon-A-Tsien MR, van der Mast RC. Source: General Hospital Psychiatry. 1996 November; 18(6): 448-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8937914

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Early recognition of delirium: review of the literature. Author(s): Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Source: Journal of Clinical Nursing. 2001 November; 10(6): 721-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11822843

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ECT in acute delirium and related clinical states. Author(s): Stromgren LS. Source: Convuls Ther. 1997 March; 13(1): 10-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9152583

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EEG in delirium. Author(s): Jacobson S, Jerrier H. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 86-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837097

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Effectiveness of ECT against delirium during an episode of bipolar disorder: a case report. Author(s): Hirose S, Horie T. Source: The Journal of Ect. 2000 September; 16(3): 316-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11005060

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Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review. Author(s): Cole MG, Primeau F, McCusker J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1996 November 1; 155(9): 1263-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8911292

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Effectiveness of interventions to prevent delirium in hospitalized patients: a systemic review. Author(s): Zeleznik J. Source: Journal of the American Geriatrics Society. 2001 December; 49(12): 1730-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11844010

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Efficacy of mianserin on symptoms of delirium in the aged: an open trial study. Author(s): Uchiyama M, Tanaka K, Isse K, Toru M. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1996 May; 20(4): 651-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8843489

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Emergence delirium: statistically significant or not? Author(s): Sikich N, Lerman J. Source: Journal of Clinical Anesthesia. 2001 March; 13(2): 157-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11393159

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Environmental risk factors for delirium in hospitalized older people. Author(s): McCusker J, Cole M, Abrahamowicz M, Han L, Podoba JE, Ramman-Haddad L. Source: Journal of the American Geriatrics Society. 2001 October; 49(10): 1327-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11890491

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Epidemiology of delirium. Author(s): Bucht G, Gustafson Y, Sandberg O. Source: Dementia and Geriatric Cognitive Disorders. 1999 September-October; 10(5): 315-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10473930

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Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium. Author(s): Camus V, Gonthier R, Dubos G, Schwed P, Simeone I. Source: Journal of Geriatric Psychiatry and Neurology. 2000 Spring; 13(1): 38-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10753006

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Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Author(s): Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK. Source: Critical Care Medicine. 2001 July; 29(7): 1370-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11445689

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Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room. Author(s): Monette J, Galbaud du Fort G, Fung SH, Massoud F, Moride Y, Arsenault L, Afilalo M. Source: General Hospital Psychiatry. 2001 January-February; 23(1): 20-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11226553

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Excitation and delirium during sevoflurane anesthesia in pediatric patients. Author(s): Veyckemans F. Source: Minerva Anestesiol. 2002 May; 68(5): 402-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12029254

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Excited delirium: does it exist? Author(s): Paquette M. Source: Perspectives in Psychiatric Care. 2003 July-September; 39(3): 93-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606228

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Extrapyramidal symptoms from intravenous haloperidol in the treatment of delirium. Author(s): Blitzstein SM, Brandt GT. Source: The American Journal of Psychiatry. 1997 October; 154(10): 1474-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9326840

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Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. Author(s): Camus V, Burtin B, Simeone I, Schwed P, Gonthier R, Dubos G. Source: International Journal of Geriatric Psychiatry. 2000 April; 15(4): 313-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10767730

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Factors associated with postoperative delirium after major head and neck surgery. Author(s): Wang SG, Lee UJ, Goh EK, Chon KM. Source: The Annals of Otology, Rhinology, and Laryngology. 2004 January; 113(1): 4851. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763573

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Failure to record delirium as a complication of intra-aortic balloon pump treatment: a retrospective study. Author(s): Glick RE, Sanders KM, Stern TA. Source: Journal of Geriatric Psychiatry and Neurology. 1996 April; 9(2): 97-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8736590

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Family-perceived distress from delirium-related symptoms of terminally ill cancer patients. Author(s): Morita T, Hirai K, Sakaguchi Y, Tsuneto S, Shima Y. Source: Psychosomatics. 2004 March-April; 45(2): 107-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15016923

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Famotidine-associated delirium. A series of six cases. Author(s): Catalano G, Catalano MC, Alberts VA. Source: Psychosomatics. 1996 July-August; 37(4): 349-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8701013

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Fatal excited delirium following cocaine use: epidemiologic findings provide new evidence for mechanisms of cocaine toxicity. Author(s): Ruttenber AJ, Lawler-Heavner J, Yin M, Wetli CV, Hearn WL, Mash DC. Source: J Forensic Sci. 1997 January; 42(1): 25-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8988571

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Fentanyl-associated delirium in man. Author(s): Crawford RD, Baskoff JD. Source: Anesthesiology. 1980 August; 53(2): 168-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7416527

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Fever, delirium, autonomic instability, and monocytosis associated with olanzapine. Author(s): Robinson RL, Burk MS, Raman S. Source: Journal of Postgraduate Medicine. 2003 January-March; 49(1): 96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865583

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Flumazenil reversal of lorazepam-induced acute delirium. Author(s): Olshaker JS, Flanigan J. Source: The Journal of Emergency Medicine. 2003 February; 24(2): 181-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12609649

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Frequency of hypoglycemic delirium in a psychiatric emergency service. Author(s): Fishbain DA, Rotundo D. Source: Psychosomatics. 1988 Summer; 29(3): 346-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3406353

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From delirium cordis to atrial fibrillation: historical development of a disease concept. Author(s): Flegel KM. Source: Annals of Internal Medicine. 1995 June 1; 122(11): 867-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7741373

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From disease to delirium: managing the declining elderly patient. Author(s): McCabe M. Source: Geriatrics. 1990 December; 45(12): 28-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2253893

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Further analyses of the Delirium Rating Scale. Author(s): Trzepacz PT, Dew MA. Source: General Hospital Psychiatry. 1995 March; 17(2): 75-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7789787

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Gamma-hydroxy butyrate withdrawal delirium: a case report. Author(s): Miglani JS, Kim KY, Chahil R. Source: General Hospital Psychiatry. 2000 May-June; 22(3): 213-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11012302

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GHB-induced delirium: a case report and review of the literature of gamma hydroxybutyric acid. Author(s): Hernandez M, McDaniel CH, Costanza CD, Hernandez OJ. Source: The American Journal of Drug and Alcohol Abuse. 1998 February; 24(1): 179-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9513637

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Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Author(s): Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Source: Anesthesiology. 1997 December; 87(6): 1298-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9416712

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H2 blocker delirium. Author(s): Picotte-Prillmayer D, DiMaggio JR, Baile WF. Source: Psychosomatics. 1995 January-February; 36(1): 74-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7871139

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Hallucination and delirium reaction to intravenous diazepam administration: case report. Author(s): Minichetti J, Milles M. Source: Anesthesia Progress. 1982 September-October; 29(5): 144-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6962677

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Hepatic encephalopathy presenting as delirium and mania. The possible role of bilirubin. Author(s): Muller N, Klages U, Gunther W. Source: General Hospital Psychiatry. 1994 March; 16(2): 138-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8039693

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High-dose intravenous haloperidol for agitated delirium following lung transplantation. Author(s): Levenson JL. Source: Psychosomatics. 1995 January-February; 36(1): 66-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7871137

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High-dose intravenous haloperidol for agitated delirium in a cardiac patient on intraaortic balloon pump. Author(s): Sanders KM, Murray GB, Cassem NH. Source: Journal of Clinical Psychopharmacology. 1991 April; 11(2): 146-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2056143

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Histamine-2 receptor blockers and delirium. Author(s): Nickell PV. Source: Annals of Internal Medicine. 1991 October 15; 115(8): 658. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1679983

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Hospital separations for delirium in Canadian psychiatric patients from 1985 to 1994. Author(s): Patten SB. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 1998 August; 43(6): 644. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9729694

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How do delirium and dementia increase length of stay of elderly general medical inpatients? Author(s): Saravay SM, Kaplowitz M, Kurek J, Zeman D, Pollack S, Novik S, Knowlton S, Brendel M, Hoffman L. Source: Psychosomatics. 2004 May-June; 45(3): 235-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15123850

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Hyperactivity in the hypothalamic-pituitary-adrenal axis in demented patients with delirium. Author(s): Robertsson B, Blennow K, Brane G, Edman A, Karlsson I, Wallin A, Gottfries CG. Source: International Clinical Psychopharmacology. 2001 January; 16(1): 39-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11195259

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Hyperlithemia correction and persistent delirium. Author(s): Swartz CM, Jones P. Source: Journal of Clinical Pharmacology. 1994 August; 34(8): 865-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7962676

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Hypernephroma presenting as acute delirium. Author(s): Hughes GS Jr, Turner RC. Source: The Journal of Urology. 1983 September; 130(3): 539-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6887372

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Hypoalbuminemia in delirium. Author(s): Dickson LR. Source: Psychosomatics. 1991 Summer; 32(3): 317-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1882023

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Hypocortisolemia and delirium in an older patient. Author(s): Cunha UG, Faria AC, de F Alves VX, Rigueirinho SA. Source: Journal of the American Geriatrics Society. 2001 May; 49(5): 688-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11380776

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Hypophosphataemia, delirium and cardiac arrhythmia in anorexia nervosa. Author(s): Mehler PS. Source: The Medical Journal of Australia. 1992 August 3; 157(3): 214. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1445589

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Hypophosphataemia, delirium and cardiac arrhythmia in anorexia nervosa. Author(s): Beumont PJ, Large M. Source: The Medical Journal of Australia. 1991 October 21; 155(8): 519-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1943930

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Hypopituitarism presenting as delirium. Author(s): Khanna S, Ammini A, Saxena S, Mohan D. Source: International Journal of Psychiatry in Medicine. 1988; 18(1): 89-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3397228

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Iatrogenic benzodiazepine withdrawal delirium in hospitalized older patients. Author(s): Moss JH, Lanctot KL. Source: Journal of the American Geriatrics Society. 1998 August; 46(8): 1020-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9706895

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ICU delirium: a case study. Author(s): Hartwick SS. Source: Critical Care Nursing Quarterly. 2003 July-September; 26(3): 221-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12930037

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Identification and management of delirium in the critically ill patient with cancer. Author(s): Morrison C. Source: Aacn Clinical Issues. 2003 February; 14(1): 92-111. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12574707

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Identifying and recognizing delirium. Author(s): Johnson J. Source: Dementia and Geriatric Cognitive Disorders. 1999 September-October; 10(5): 353-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10473939

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Immunology of delirium: new opportunities for treatment and research. Author(s): Broadhurst C, Wilson K. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2001 October; 179: 288-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11581107

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Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Author(s): Caraceni A, Nanni O, Maltoni M, Piva L, Indelli M, Arnoldi E, Monti M, Montanari L, Amadori D, De Conno F. Source: Cancer. 2000 September 1; 89(5): 1145-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10964345

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Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus. Author(s): Morita T, Tei Y, Inoue S. Source: Journal of Pain and Symptom Management. 2003 September; 26(3): 827-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12967731

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Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Author(s): Rolfson DB, McElhaney JE, Rockwood K, Finnegan BA, Entwistle LM, Wong JF, Suarez-Almazor ME. Source: The Canadian Journal of Cardiology. 1999 July; 15(7): 771-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10411615

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Incidence of and preoperative predictors for delirium after cardiac surgery. Author(s): van der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JD. Source: Journal of Psychosomatic Research. 1999 May; 46(5): 479-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10404482

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Increased plasma morphine metabolites in terminally ill cancer patients with delirium: an intra-individual comparison. Author(s): Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Source: Journal of Pain and Symptom Management. 2002 February; 23(2): 107-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11844630

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Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Author(s): Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Source: Intensive Care Medicine. 2001 May; 27(5): 859-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11430542

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Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment. Author(s): Granberg Axell AI, Malmros CW, Bergbom IL, Lundberg DB. Source: Acta Anaesthesiologica Scandinavica. 2002 July; 46(6): 726-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12059899

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Intractable delirium associated with ziconotide successfully treated with electroconvulsive therapy. Author(s): Levin T, Petrides G, Weiner J, Saravay S, Multz AS, Bailine S. Source: Psychosomatics. 2002 January-February; 43(1): 63-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11927761

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Intravenous flunitrazepam in the treatment of alcohol withdrawal delirium. Author(s): Pycha R, Miller C, Barnas C, Hummer M, Stuppack C, Whitworth A, Fleischhacker WW. Source: Alcoholism, Clinical and Experimental Research. 1993 August; 17(4): 753-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8214408

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Introduction: the puzzles of delirium. Author(s): Kamholz B. Source: Journal of Geriatric Psychiatry and Neurology. 1998 Fall; 11(3): 115-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9894729

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Involuntary hospitalization of delirium patients in Israel: a psychiatric case register study. Author(s): Heinik J, Mester R, Avnon M. Source: Med Law. 1997; 16(1): 111-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9212607

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Is delirium different when it occurs in dementia? A study using the delirium rating scale. Author(s): Trzepacz PT, Mulsant BH, Amanda Dew M, Pasternak R, Sweet RA, Zubenko GS. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 1998 Spring; 10(2): 199-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9608409

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Is dopamine administration possibly a risk factor for delirium? Author(s): Sommer BR, Wise LC, Kraemer HC. Source: Critical Care Medicine. 2002 July; 30(7): 1508-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130971

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Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Author(s): Trzepacz PT. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 132-48. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837102

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Itraconazole-induced delirium. Author(s): Mittal D, Wikaitis J. Source: Psychosomatics. 2003 May-June; 44(3): 260-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724511

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JAMA patient page. Delirium. Author(s): Torpy JM, Lynm C, Glass RM. Source: Jama : the Journal of the American Medical Association. 2004 April 14; 291(14): 1794. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082707

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Ketamine-induced postanesthetic delirium attenuated by tetrahydroaminoacridine. Author(s): Albin MS, Bunegin L, Massopust LC Jr, Jannetta PJ. Source: Experimental Neurology. 1974 July; 44(1): 126-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4857761

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Ketoprofen intoxication delirium. Author(s): Tavcar R, Dernovsek MZ, Brosch S. Source: Journal of Clinical Psychopharmacology. 1999 February; 19(1): 95-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9934949

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L-5-Hydroxytryptophan-induced delirium. Author(s): Irwin M, Fuentenebro F, Marder SR, Yuwiler A. Source: Biological Psychiatry. 1986 June; 21(7): 673-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3486678

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Language function in delirium: a comparison of single word processing in acute confusional states and probable Alzheimer's disease. Author(s): Wallesch CW, Hundsalz A. Source: Brain and Language. 1994 May; 46(4): 592-606. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8044677

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Large neutral amino acid changes and delirium in febrile elderly medical patients. Author(s): Flacker JM, Lipsitz LA. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 May; 55(5): B249-52; Discussion B253-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10819312

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Legal aspects of the treatment of delirium. Author(s): Fogel BS, Mills MJ, Landen JE. Source: Hosp Community Psychiatry. 1986 February; 37(2): 154-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2867968

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Length of hospitalization and disposition of elderly vs younger delirium patients in psychiatric hospitals. Author(s): Heinik J, Avnon M, Hes JP. Source: The Israel Journal of Psychiatry and Related Sciences. 1997; 34(2): 115-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9231572

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Letter: Reversal by physostigmine of clozapine-induced delirium. Author(s): Schuster P, Gabriel E, Kufferle B, Karobath M. Source: Lancet. 1976 January 3; 1(7949): 37-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=54535

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Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients. Author(s): Anthony JC, LeResche L, Niaz U, von Korff MR, Folstein MF. Source: Psychological Medicine. 1982 May; 12(2): 397-408. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7100362

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Lithium-induced delirium with therapeutic serum lithium levels: a case report. Author(s): Brown AS, Rosen J. Source: Journal of Geriatric Psychiatry and Neurology. 1992 January-March; 5(1): 53-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1571075

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Long-term heavy use of diphenhydramine without anticholinergic delirium. Author(s): Isabelle C, Warner A. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1999 March 15; 56(6): 555-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10192692

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Long-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer. Author(s): Ramani S, Karnad AB. Source: Southern Medical Journal. 1996 November; 89(11): 1101-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8903298

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Low dose propranolol-induced delirium: 3 cases report and a review of literature. Author(s): Chen WH, Liu JS, Chang YY. Source: Gaoxiong Yi Xue Ke Xue Za Zhi. 1994 January; 10(1): 40-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8176767

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Low muscle mass of the thigh is significantly correlated with delirium and worse functional outcome in older medical patients. Author(s): Weinrebe W, Guneysu S, Welz-Barth A. Source: Journal of the American Geriatrics Society. 2002 July; 50(7): 1310-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12133034

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Low serum albumin levels and risk of delirium. Author(s): Trzepacz PT, Francis J. Source: The American Journal of Psychiatry. 1990 May; 147(5): 675. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2327504

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Loxapine versus olanzapine in the treatment of delirium following traumatic brain injury. Author(s): Krieger D, Hansen K, McDermott C, Matthews R, Mitchell R, Bollegala N, Bhalerao S. Source: Neurorehabilitation. 2003; 18(3): 205-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530585

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Management of acute delirium in hospitalized elderly: a process improvement project. Author(s): Simon L, Jewell N, Brokel J. Source: Geriatric Nursing (New York, N.Y.). 1997 July-August; 18(4): 150-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9274162

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Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea. Author(s): Ross DD, Alexander CS. Source: American Family Physician. 2001 September 15; 64(6): 1019-26. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11578023

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Managing delirium and agitation in elderly hospitalized orthopaedic patients: Part 2-Interventions. Author(s): Segatore M, Adams D. Source: Orthopaedic Nursing / National Association of Orthopaedic Nurses. 2001 March-April; 20(2): 61-73; Quiz 73-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12024636

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Managing delirium and agitation in elderly hospitalized orthopaedic patients: Part I-Theoretical aspects. Author(s): Segatore M, Adams D. Source: Orthopaedic Nursing / National Association of Orthopaedic Nurses. 2001 January-February; 20(1): 31-43; Quiz 44-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12024513

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Managing delirium in adult intensive care patients. Author(s): Roberts BL. Source: Critical Care Nurse. 2001 February; 21(1): 48-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11858244

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Managing delirium in the palliative care of older people. Author(s): Shury A. Source: Nursing Older People. 2002 June; 14(4): 16-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094514

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Managing geriatric psychiatric emergencies: delirium and dementia. Author(s): Antai-Otong D. Source: Nurs Clin North Am. 2003 March; 38(1): 123-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12712674

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Measuring delirium severity in older general hospital inpatients without dementia. The Delirium Severity Scale. Author(s): Bettin KM, Maletta GJ, Dysken MW, Jilk KM, Weldon DT, Kuskowski M, Mach JR Jr. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 1998 Fall; 6(4): 296-307. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9793578

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Melatonin for treatment and prevention of postoperative delirium. Author(s): Hanania M, Kitain E. Source: Anesthesia and Analgesia. 2002 February; 94(2): 338-9, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11812694

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Missed delirium in older emergency department patients: a quality-of-care problem. Author(s): Sanders AB. Source: Annals of Emergency Medicine. 2002 March; 39(3): 338-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11867994

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Monitoring cognitive disturbance in delirium with the ten-point clock test. Author(s): Manos PJ. Source: International Journal of Geriatric Psychiatry. 1998 September; 13(9): 646-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9777433

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Monitoring delirium in critically ill patients. Using the confusion assessment method for the intensive care unit. Author(s): Truman B, Ely EW. Source: Critical Care Nurse. 2003 April; 23(2): 25-36; Quiz 37-8. Review. Erratum In: Crit Care Nurse. 2003 June; 23(3): 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725193

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Monitoring sedation, agitation, analgesia, and delirium in critically ill adult patients. Author(s): Fraser GL, Riker RR. Source: Critical Care Clinics. 2001 October; 17(4): 967-87. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11762270

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Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion: no relation of early death, stroke, and delirium to the duration of circulatory arrest. Author(s): Okita Y, Takamoto S, Ando M, Morota T, Matsukawa R, Kawashima Y. Source: The Journal of Thoracic and Cardiovascular Surgery. 1998 January; 115(1): 12938. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9451056

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Motoric subtypes of delirium. Author(s): Meagher DJ, Trzepacz PT. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 75-85. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837096

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Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Author(s): Rizzo JA, Bogardus ST Jr, Leo-Summers L, Williams CS, Acampora D, Inouye SK. Source: Medical Care. 2001 July; 39(7): 740-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458138

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Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment. Author(s): Britton A, Russell R. Source: Cochrane Database Syst Rev. 2000; (2): Cd000395. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796541

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Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment. Author(s): Britton A, Russell R. Source: Cochrane Database Syst Rev. 2001; (1): Cd000395. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279689

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Need we do so badly in managing delirium in elderly patients? Author(s): Rockwood K. Source: Age and Ageing. 2003 September; 32(5): 473-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12957992

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Neuropathogenesis of delirium. Author(s): Manos PJ. Source: Psychosomatics. 1995 March-April; 36(2): 156-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7724719

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Neuropathogenesis of delirium. Author(s): Ovsiew F. Source: Psychosomatics. 1995 March-April; 36(2): 156; Author Reply 157. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7724718

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Neuropsychiatric assessment of liver transplantation candidates: delirium and other psychiatric disorders. Author(s): Trzepacz PT, Maue FR, Coffman G, Van Thiel DH. Source: International Journal of Psychiatry in Medicine. 1986-87; 16(2): 101-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3528007

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Nicotine withdrawal as an etiologic factor in delirium. Author(s): Gallagher R. Source: Journal of Pain and Symptom Management. 1998 August; 16(2): 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9737096

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Nizatidine-induced delirium in a nonagenarian. Author(s): Galynker II, Tendler DS. Source: The Journal of Clinical Psychiatry. 1997 July; 58(7): 327. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9269259

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Nurses' recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Author(s): Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM Jr. Source: Archives of Internal Medicine. 2001 November 12; 161(20): 2467-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11700159

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Nursing assessment, management of delirium in the elderly. Author(s): Sullivan EM, Wanich CK, Kurlowicz LH. Source: Aorn Journal. 1991 March; 53(3): 820, 822, 824-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2031597

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Obstructive sleep apnea presenting as acute delirium. Author(s): Whitney JF, Gannon DE. Source: The American Journal of Emergency Medicine. 1996 May; 14(3): 270-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8639200

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Occurrence and impact of suspected delirium in hospitalized elderly patients. Author(s): Forman LJ, Cavalieri TA, Galski T, Dinsmore S, Kay PA, Pomerantz S. Source: J Am Osteopath Assoc. 1995 October; 95(10): 588-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8557547

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Occurrence of mirtazapine-induced delirium in organic brain disorder. Author(s): Bailer U, Fischer P, Kufferle B, Stastny J, Kasper S. Source: International Clinical Psychopharmacology. 2000 July; 15(4): 239-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10954066

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Occurrence of trazodone-induced delirium. Author(s): Lennkh C, Fischer P, Kufferle B, Kasper S. Source: International Clinical Psychopharmacology. 1998 September; 13(5): 225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9817628

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Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Author(s): Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, Bruera ED. Source: Archives of Internal Medicine. 2000 March 27; 160(6): 786-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10737278

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Ofloxacin-induced delirium. Author(s): Fennig S, Mauas L. Source: The Journal of Clinical Psychiatry. 1992 April; 53(4): 137-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1564051

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Olanzapine in the treatment of delirium. Author(s): Sipahimalani A, Masand PS. Source: Psychosomatics. 1998 September-October; 39(5): 422-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9775699

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Olanzapine may cause delirium in geriatric patients. Author(s): Samuels S, Fang M. Source: The Journal of Clinical Psychiatry. 2004 April; 65(4): 582-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15119927

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Olanzapine vs haloperidol: treating delirium in a critical care setting. Author(s): Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Source: Intensive Care Medicine. 2004 March; 30(3): 444-9. Epub 2003 December 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685663

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Omeprazole-induced delirium. Author(s): Heckmann JG, Birklein F, Neundorfer B. Source: Journal of Neurology. 2000 January; 247(1): 56-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10701899

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Ondansetron hydrochloride for the treatment of delirium after coronary artery surgery. Author(s): Bayindir O, Guden M, Akpinar B, Sanisoglu I, Sagbas E. Source: The Journal of Thoracic and Cardiovascular Surgery. 2001 January; 121(1): 176-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11135174

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Operative predictors of delirium after pulmonary thromboendarterectomy. A model for postcardiotomy delirium? Author(s): Wragg RE, Dimsdale JE, Moser KM, Daily PO, Dembitsky WP, Archibald C. Source: The Journal of Thoracic and Cardiovascular Surgery. 1988 October; 96(4): 524-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3172798

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Optimising management of delirium. Patients with delirium should be treated with care. Author(s): Tabet N, Howard R. Source: Bmj (Clinical Research Ed.). 2001 June 30; 322(7302): 1602-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458900

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Optimising management of delirium. Placebo controlled trials of pharmacological treatments are needed. Author(s): Ryan CJ. Source: Bmj (Clinical Research Ed.). 2001 June 30; 322(7302): 1602; Author Reply 1603. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458901

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Optimising management of delirium. Withdrawal of Droleptan (droperidol). Author(s): Haines J, Barclay P, Wauchob T. Source: Bmj (Clinical Research Ed.). 2001 June 30; 322(7302): 1603. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11458902

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Out of the furrow and into the fire: where do we go with delirium? Author(s): Rockwood KJ. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 October 1; 167(7): 763-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12389838

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Outcome of delirium: Part 1. Outcome of delirium diagnosed by DSM-III-R, ICD-10 and CAMDEX and derivation of the Reversible Cognitive Dysfunction Scale among acute geriatric inpatients. Author(s): Treloar AJ, Macdonald AJ. Source: International Journal of Geriatric Psychiatry. 1997 June; 12(6): 609-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9215940

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Outcome of delirium: part 2. Clinical features of reversible cognitive dysfunction--are they the same as accepted definitions of delirium? Author(s): Treloar AJ, Macdonald AJ. Source: International Journal of Geriatric Psychiatry. 1997 June; 12(6): 614-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9215941

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Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients. Author(s): Uldall KK, Harris VL, Lalonde B. Source: Comprehensive Psychiatry. 2000 March-April; 41(2): 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10741884

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Outcomes of delirium: can systems of care make a difference? Author(s): Francis J. Source: Journal of the American Geriatrics Society. 1997 February; 45(2): 247-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9033530

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Pethidine reverses morphine-induced delirium. Author(s): McLoughlin PD. Source: Anaesthesia and Intensive Care. 2000 June; 28(3): 311-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10853216

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Physicians vary in approaches to the clinical management of delirium. Author(s): Carnes M, Howell T, Rosenberg M, Francis J, Hildebrand C, Knuppel J. Source: Journal of the American Geriatrics Society. 2003 February; 51(2): 234-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12558721

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Possible ergotamine-caffeine-associated delirium. Author(s): Gulbranson SH, Mock RE, Wolfrey JD. Source: Pharmacotherapy. 2002 January; 22(1): 126-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11794425

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Postictal delirium after right-unilateral electroconvulsive therapy caused by nonprototypical hemispheric asymmetry. Author(s): Sakauye K, Berry T, Gremillion P. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2003 July-August; 11(4): 469. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837677

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Postoperative delirium and melatonin levels in elderly patients. Author(s): Shigeta H, Yasui A, Nimura Y, Machida N, Kageyama M, Miura M, Menjo M, Ikeda K. Source: American Journal of Surgery. 2001 November; 182(5): 449-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11754849

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Postoperative delirium indicating an adverse drug interaction involving the selective serotonin reuptake inhibitor, paroxetine? Author(s): Palmer JL. Source: Journal of Psychopharmacology (Oxford, England). 2000 June; 14(2): 186-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10890314

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Postoperative delirium mimicking epilepsy. Author(s): Makker R, Yanny W. Source: Anaesthesia. 2000 June; 55(6): 601. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10866741

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Potentiating the problem of delirium? Author(s): Goodwin M. Source: Critical Care Nurse. 2003 August; 23(4): 13; Author Reply 13-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12961779

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Predicting delirium after vascular surgery: a model based on pre- and intraoperative data. Author(s): Bohner H, Hummel TC, Habel U, Miller C, Reinbott S, Yang Q, Gabriel A, Friedrichs R, Muller EE, Ohmann C, Sandmann W, Schneider F. Source: Annals of Surgery. 2003 July; 238(1): 149-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832977

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Predictors of delirium after cardiac surgery delirium: effect of beating-heart (offpump) surgery. Author(s): Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW. Source: The Journal of Thoracic and Cardiovascular Surgery. 2004 January; 127(1): 57-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752413

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Pregnancy as delirium. Author(s): Di Renzo GC. Source: J Matern Fetal Neonatal Med. 2002 September;12(3):145-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12530610

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Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Author(s): Inouye SK. Source: Annals of Medicine. 2000 May; 32(4): 257-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10852142

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Probable dementia with Lewy bodies and risperidone-induced delirium. Author(s): Morikawa M, Kishimoto T. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 December; 47(10): 976. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553140

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Probable Lewy body dementia presenting as "delirium". Author(s): Robinson MJ. Source: Psychosomatics. 2002 January-February; 43(1): 84-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11927768

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Quantitative measurement of brain electrical activity in delirium. Author(s): Leuchter AF, Jacobson SA. Source: Int Psychogeriatr. 1991 Winter; 3(2): 231-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1811776

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Quetiapine for treatment-resistant delirium. Author(s): Al-Samarrai S, Dunn J, Newmark T, Gupta S. Source: Psychosomatics. 2003 July-August; 44(4): 350-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832605

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Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. Author(s): Kales HC, Kamholz BA, Visnic SG, Blow FC. Source: Journal of Geriatric Psychiatry and Neurology. 2003 March; 16(1): 32-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12641371

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Recovery characteristics and post-operative delirium after long-duration laparoscopeassisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia. Author(s): Nishikawa K, Nakayama M, Omote K, Namiki A. Source: Acta Anaesthesiologica Scandinavica. 2004 February; 48(2): 162-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14995937

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Regional cerebral blood flow in delirium patients. Author(s): Yokota H, Ogawa S, Kurokawa A, Yamamoto Y. Source: Psychiatry and Clinical Neurosciences. 2003 June; 57(3): 337-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12753576

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Resolving the delirium dilemma. Author(s): Ignatavicius D. Source: Nursing. 1999 October; 29(10): 41-6; Quiz N289. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10797671

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Risk factors for development of delirium among oncology patients. Author(s): Ljubisavljevic V, Kelly B. Source: General Hospital Psychiatry. 2003 September-October; 25(5): 345-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972226

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Risperidone in the treatment of acute confusional state (delirium) due to neuropsychiatric lupus erythematosus: case report. Author(s): Nishimura K, Omori M, Horikawa N, Tanaka E, Furuya T, Harigai M. Source: International Journal of Psychiatry in Medicine. 2003; 33(3): 299-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15089010

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Risperidone in the treatment of delirium: results from a prospective open-label trial. Author(s): Mittal D, Jimerson NA, Neely EP, Johnson WD, Kennedy RE, Torres RA, Nasrallah HA. Source: The Journal of Clinical Psychiatry. 2004 May; 65(5): 662-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15163252

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Risperidone in the treatment of patients with delirium. Author(s): Parellada E, Baeza I, de Pablo J, Martinez G. Source: The Journal of Clinical Psychiatry. 2004 March; 65(3): 348-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15096074

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Rivastigmine in prevention of delirium in a 65 years old man with Parkinson's disease. Author(s): Dautzenberg PL, Wouters CJ, Oudejans I, Samson MM. Source: International Journal of Geriatric Psychiatry. 2003 June; 18(6): 555-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12789683

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Sedation for delirium and other symptoms in terminally ill patients in Edmonton. Author(s): Fainsinger RL, De Moissac D, Mancini I, Oneschuk D. Source: Journal of Palliative Care. 2000 Summer; 16(2): 5-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10887726

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Serotonin and amino acids: partners in delirium pathophysiology? Author(s): van der Mast RC, Fekkes D. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 125-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837101

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Serum anticholinergic activity levels and delirium in the elderly. Author(s): Tune LE. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 149-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837103

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Southwestern Internal Medicine Conference. Etiology and management of delirium. Author(s): Roche V. Source: The American Journal of the Medical Sciences. 2003 January; 325(1): 20-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544081

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Steroid-induced delirium in a patient with asthma: report of one case. Author(s): Koh YI, Choi IS, Shin IS, Hong SN, Kim YK, Sim MK. Source: Korean J Intern Med. 2002 June; 17(2): 150-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12164094

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Studying delirium. Author(s): Anderson SD, Hewko RA. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 March 4; 168(5): 541; Author Reply 541-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12615740

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Symptoms of delirium among elderly medical inpatients with or without dementia. Author(s): Cole MG, McCusker J, Dendukuri N, Han L. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2002 Spring; 14(2): 167-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11983791

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Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. Author(s): Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ, Laplante J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 October 1; 167(7): 753-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12389836

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Systematic intervention for supporting community care of elderly people after a delirium episode. Author(s): Rahkonen T, Eloniemi-Sulkava U, Paanila S, Halonen P, Sivenius J, Sulkava R. Source: Int Psychogeriatr. 2001 March; 13(1): 37-49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11352333

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The cause of delirium in patients with hip fracture. Author(s): Brauer C, Morrison RS, Silberzweig SB, Siu AL. Source: Archives of Internal Medicine. 2000 June 26; 160(12): 1856-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10871981

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The course of delirium in older medical inpatients: a prospective study. Author(s): McCusker J, Cole M, Dendukuri N, Han L, Belzile E. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 September; 18(9): 696-704. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12950477

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The epidemiology of delirium: a review of studies and methodological issues. Author(s): Fann JR. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 64-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837095

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The four 'I's of delirium. Author(s): Crausman RS. Source: Journal of the American Geriatrics Society. 2004 April; 52(4): 645. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15066091

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The interaction of delirium and seizures. Author(s): Fink M. Source: Semin Clin Neuropsychiatry. 2000 April; 5(2): 93-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10837098

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The measurement of delirium: review of scales. Author(s): Schuurmans MJ, Deschamps PI, Markham SW, Shortridge-Baggett LM, Duursma SA. Source: Res Theory Nurs Pract. 2003 Fall; 17(3): 207-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14655974

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The relation between the clinical subtypes of delirium and the urinary level of 6SMT. Author(s): Balan S, Leibovitz A, Zila SO, Ruth M, Chana W, Yassica B, Rahel B, Richard G, Neumann E, Blagman B, Habot B. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Summer; 15(3): 363-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928514

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The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. Author(s): Bayindir O, Akpinar B, Can E, Guden M, Sonmez B, Demiroglu C. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2000 June; 14(3): 288-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10890483

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Treatment for delirium with risperidone: results of a prospective open trial with 10 patients. Author(s): Horikawa N, Yamazaki T, Miyamoto K, Kurosawa A, Oiso H, Matsumoto F, Nishimura K, Karasawa K, Takamatsu K. Source: General Hospital Psychiatry. 2003 July-August; 25(4): 289-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12850662

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Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report. Author(s): Slatkin N, Rhiner M. Source: Journal of Pain and Symptom Management. 2004 March; 27(3): 268-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15038335

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•

Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. Author(s): Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Source: Journal of Pain and Symptom Management. 2001 December; 22(6): 997-1006. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11738162

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Update on the neuropathogenesis of delirium. Author(s): Trzepacz PT. Source: Dementia and Geriatric Cognitive Disorders. 1999 September-October; 10(5): 330-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10473933

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Usage of haloperidol for delirium in cancer patients. Author(s): Akechi T, Uchitomi Y, Okamura H, Fukue M, Kagaya A, Nishida A, Oomori N, Yamawaki S. Source: Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 1996 September; 4(5): 390-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8883234

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Use of high dose benzodiazepines in alcohol and sedative withdrawal delirium. Author(s): Kunkel EJ, Rodgers C, DeMaria PA Jr, Holleran D, Zaimes J, Gray C, Zager R, Hall SM, Field HL. Source: General Hospital Psychiatry. 1997 July; 19(4): 286-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9327258

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Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Author(s): Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M. Source: Archives of Internal Medicine. 2001 April 23; 161(8): 1099-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11322844

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Use of propofol for alcohol withdrawal delirium: a case report. Author(s): Takeshita J. Source: The Journal of Clinical Psychiatry. 2004 January; 65(1): 134-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14974494

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Use of quetiapine in delirium: case reports. Author(s): Torres R, Mittal D, Kennedy R. Source: Psychosomatics. 2001 July-August; 42(4): 347-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11496025

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Use of risperidone in delirium: case reports. Author(s): Sipahimalani A, Masand PS. Source: Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists. 1997 June; 9(2): 105-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9242897

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Use of the cognitive test for delirium in patients with traumatic brain injury. Author(s): Kennedy RE, Nakase-Thompson R, Nick TG, Sherer M. Source: Psychosomatics. 2003 July-August; 44(4): 283-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832593

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Validating the diagnosis of delirium and evaluating its association with deterioration over a one-year period. Author(s): Katz IR, Curyto KJ, TenHave T, Mossey J, Sands L, Kallan MJ. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2001 Spring; 9(2): 148-59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11316619

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Validation of a cognitive test for delirium in medical ICU patients. Author(s): Hart RP, Levenson JL, Sessler CN, Best AM, Schwartz SM, Rutherford LE. Source: Psychosomatics. 1996 November-December; 37(6): 533-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8942204

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Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. Author(s): Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2001 Spring; 13(2): 229-42. Erratum In: J Neuropsychiatry Clin Neurosci 2001 Summer; 13(3): 433. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11449030

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Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Author(s): Fabbri RM, Moreira MA, Garrido R, Almeida OP. Source: Arquivos De Neuro-Psiquiatria. 2001 June; 59(2-A): 175-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11400020

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Validity of the confusion assessment method in detecting postoperative delirium in the elderly. Author(s): Rolfson DB, McElhaney JE, Jhangri GS, Rockwood K. Source: Int Psychogeriatr. 1999 December; 11(4): 431-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10631588

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Venlafaxine-induced delirium. Author(s): Howe C, Ravasia S. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 March; 48(2): 129. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12655917

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Violence in the workplace. Delirium should be considered. Author(s): MacHale S. Source: Bmj (Clinical Research Ed.). 2002 March 30; 324(7340): 788. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11923167

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Visual hallucinations and delirium during treatment with amantadine (Symmetrel). Author(s): Postma JU, Van Tilburg W. Source: Journal of the American Geriatrics Society. 1975 May; 23(5): 212-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=123540

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What criteria should be used for the diagnosis of delirium? Author(s): Liptzin B. Source: Dementia and Geriatric Cognitive Disorders. 1999 September-October; 10(5): 364-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10473941

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What nurses need to know about drugs as a cause of delirium. Author(s): Miller CA. Source: Geriatric Nursing (New York, N.Y.). 2004 March-April; 25(2): 124-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15107800

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Writing disturbances: an indicator for postoperative delirium. Author(s): Aakerlund LP, Rosenberg J. Source: International Journal of Psychiatry in Medicine. 1994; 24(3): 245-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7890482

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Ziprasidone treatment of delirium. Author(s): Leso L, Schwartz TL. Source: Psychosomatics. 2002 January-February; 43(1): 61-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11927760

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Zolpidem-induced delirium with mania in an elderly woman. Author(s): Hill KP, Oberstar JV, Dunn ER. Source: Psychosomatics. 2004 January-February; 45(1): 88-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709766

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Zolpidem-related delirium: a case report. Author(s): Freudenreich O, Menza M. Source: The Journal of Clinical Psychiatry. 2000 June; 61(6): 449-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10901348

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CHAPTER 2. NUTRITION AND DELIRIUM Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and delirium.

Finding Nutrition Studies on Delirium The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “delirium” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “delirium” (or a synonym): •

Anticholinergic delirium caused by topical homatropine ophthalmologic solution: confirmation by anticholinergic radioreceptor assay in two cases. Author(s): Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Source: Tune, L E Bylsma, F W Hilt, D C J-Neuropsychiatry-Clin-Neurosci. 1992 Spring; 4(2): 195-7 0895-0172

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Repeated delirium from homatropine eye-drops. A case report. Source: Delberghe, X Zegers de Beyl, D Clin-Neurol-Neurosurg. 1987; 89(1): 53-4 03038467

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Toxic delirium due to Datura stramonium. Author(s): Department of Emergency Medicine, Poriya Government Hospital, Tiberias, Israel. [email protected] Source: Kurzbaum, A Simsolo, C Kvasha, L Blum, A Isr-Med-Assoc-J. 2001 July; 3(7): 538-9 1565-1088

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Treatment of acute nonspecific delirium with i.v. haloperidol in surgical intensive care patients. Source: Moulaert, P Acta-Anaesthesiol-Belg. 1989; 40(3): 183-6 0001-5164

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND DELIRIUM Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to delirium. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to delirium and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “delirium” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to delirium: •

“Murder!” she said: a case of iatrogenic delirium. Author(s): Edmands MS. Source: Issues in Mental Health Nursing. 1995 March-April; 16(2): 109-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7706061

•

Cardiac complications and delirium associated with valerian root withdrawal. Author(s): Garges HP, Varia I, Doraiswamy PM. Source: Jama : the Journal of the American Medical Association. 1998 November 11; 280(18): 1566-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9820254

•

Datura delirium. Author(s): Hanna JP, Schmidley JW, Braselton WE Jr.

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Source: Clinical Neuropharmacology. 1992 April; 15(2): 109-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1591736 •

Delirium after cataract extraction: a prospective study. Author(s): Chaudhuri S, Mahar RS, Gurunadh VS. Source: J Indian Med Assoc. 1994 August; 92(8): 268-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7963616

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Delirium in surgical patients under intensive care. Utility of mental status examination. Author(s): Katz NM, Agle DP, DePalma RG, DeCosse JJ. Source: Archives of Surgery (Chicago, Ill. : 1960). 1972 March; 104(3): 310-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5010842

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Delirium induced by topical application of podophyllin: a case report. Author(s): Stoudemire A, Baker N, Thompson TL 2nd. Source: The American Journal of Psychiatry. 1981 November; 138(11): 1505-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6895278

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Delirium: recognition and management in the older patient. Author(s): Zisook S, Braff DL. Source: Geriatrics. 1986 June; 41(6): 67-7O, 72-3, 77-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2872139

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Dreaming as delirium: a mental status analysis of our nightly madness. Author(s): Hobson JA. Source: Seminars in Neurology. 1997 June; 17(2): 121-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9195654

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Effect of a reorientation technique on postcardiotomy delirium. Author(s): Budd S, Brown W. Source: Nursing Research. 1974 July-August; 23(4): 341-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4495272

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Factors associated with sudden death of individuals requiring restraint for excited delirium. Author(s): Stratton SJ, Rogers C, Brickett K, Gruzinski G. Source: The American Journal of Emergency Medicine. 2001 May; 19(3): 187-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11326341

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Herbal medicines as a factor in delirium. Author(s): Khawaja IS, Marotta RF, Lippmann S.

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Source: Psychiatric Services (Washington, D.C.). 1999 July; 50(7): 969-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10402626 •

Intensive care delirium. The effect of outside deprivation in a windowless unit. Author(s): Wilson LM. Source: Archives of Internal Medicine. 1972 August; 130(2): 225-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5050558

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Letter: Reversal by physostigmine of delirium induced by ingestion of the flowers of the plant Datura stramonium. Author(s): Mendelson G. Source: Anesthesia and Analgesia. 1976 March-April; 55(2): 260. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=943988

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Motor activity rhythm in dementia with delirium. Author(s): Honma H, Kohsaka M, Suzuki I, Fukuda N, Kobayashi R, Sakakibara S, Matubara S, Koyama T. Source: Psychiatry and Clinical Neurosciences. 1998 April; 52(2): 196-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9628148

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Postcardiotomy delirium: a critical review. Author(s): Dubin WR, Field HL, Gastfriend DR. Source: The Journal of Thoracic and Cardiovascular Surgery. 1979 April; 77(4): 586-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=370460

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Post-pump delirium. Author(s): Tucker LA. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1993 December; 9(4): 269-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8274838

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Pseudodementia and delirium in depression: a contribution to psychosomatic medicine. Author(s): Koide H. Source: Jpn J Psychiatry Neurol. 1992 December; 46(4): 869-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1304611

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Psychosis and delirium following metabolife use. Author(s): Verduin ML, Labbate LA.

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Source: Psychopharmacology Bulletin. 2002 Summer; 36(3): 42-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12473963 •

Psychosocial and management aspects of delirium. Author(s): Rabins PV. Source: Int Psychogeriatr. 1991 Winter; 3(2): 319-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1811783

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Reversal of datura stramonium delirium with physostigmine: report of three cases. Author(s): Orr R. Source: Anesthesia and Analgesia. 1975 January-February; 54(1): 158. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1167756

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The relationship of postoperative delirium with psychoactive medications. Author(s): Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, Katz N, Cook EF, Orav EJ, Lee TH. Source: Jama : the Journal of the American Medical Association. 1994 November 16; 272(19): 1518-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7966844

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The reversal of anticholinergic drug-induced delirium and coma with physostigmine. Author(s): Heiser JF, Gillin JC. Source: The American Journal of Psychiatry. 1971 February; 127(8): 1050-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5099944

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Toxic delirium induced by deliberate ingestion of Jimson weed. Author(s): Dew JM. Source: J Ky Med Assoc. 1977 September; 75(9): 434-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=903706

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Treatment of delirium--a reappraisal. Author(s): Steinhart MJ. Source: International Journal of Psychiatry in Medicine. 1978-79; 9(2): 191-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=39037

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Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. Author(s): Pollanen MS, Chiasson DA, Cairns JT, Young JG. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1998 June 16; 158(12): 1603-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9645173

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to delirium; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alcohol Withdrawal Source: Healthnotes, Inc.; www.healthnotes.com Alcoholism Source: Integrative Medicine Communications; www.drkoop.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com Hyperthyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypothermia Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Prima Communications, Inc.www.personalhealthzone.com

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•

Delirium

Chinese Medicine Angong Niuhuang Wan Alternative names: Angong Niuhuang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Bawei Chenxiang San Alternative names: Bawei Chenxiang Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Ershiwuwei Zhenzhu Wan Alternative names: rshiwuwei Zhenzhu Pills (Used by Tibetan Nationality); Ershiwuwei Zhenzhu Wan (Er Shi Wu Wei Zhen Zhu Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jufang Zhibao San Alternative names: Jufang Zhibao Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Lianqiao Alternative names: Weeping Forsythia Capsule; Fructus Forsythiae Source: Chinese Materia Medica Shuiniujiao Alternative names: Buffalo Horn; Cornu Bubali Source: Chinese Materia Medica

•

Herbs and Supplements Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hops Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hypericum Perforatum Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Perphenazine Source: Healthnotes, Inc.; www.healthnotes.com

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Risperidone Source: Healthnotes, Inc.; www.healthnotes.com Skullcap Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Thioridazine Source: Healthnotes, Inc.; www.healthnotes.com Valerian Alternative names: Valeriana officinalis Source: Healthnotes, Inc.; www.healthnotes.com Valerian Source: Prima Communications, Inc.www.personalhealthzone.com Wild Indigo Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON DELIRIUM Overview In this chapter, we will give you a bibliography on recent dissertations relating to delirium. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “delirium” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on delirium, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Delirium ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to delirium. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

An exploration of the incidence, patterns and course, and correlates of delirium among patients undergoing off-pump coronary artery bypass graft surgery by Watanuki, Shigeaki, PhD from UNIVERSITY OF MINNESOTA, 2003, 196 pages http://wwwlib.umi.com/dissertations/fullcit/3080129

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Prevalence of delirium and its relationship to symptom distress in terminally ill cancer patients by Brown, Sarah Jane, MN from THE UNIVERSITY OF MANITOBA (CANADA), 2003, 99 pages http://wwwlib.umi.com/dissertations/fullcit/MQ79933

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON DELIRIUM Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “delirium” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on delirium, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Delirium By performing a patent search focusing on delirium, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on delirium: •

Human neurotensin receptor type 2 and splice variants thereof Inventor(s): Bergsma; Derk Jon (Berwyn, PA), Shabon; Usman (Swarthmore, PA) Assignee(s): SmithKline Beecham Corporation (Philadelphia, PA) Patent Number: 6,008,050 Date filed: April 2, 1997 Abstract: Human neurotensin type 2 polypeptides and polynucleotides and methods for producing such polypeptides by recombinant techniques are disclosed. Also disclosed are methods for utilizing human neurotensin type 2 polypeptides and polynucleotides in the design of protocols for the treatment of infections such as bacterial, fungal, protozoan and viral infections, particularly infections caused by HIV-1 or HIV-2; pain; cancers; anorexia; bulimia; asthma; Parkinson's disease; acute heart failure; hypotension; hypertension; urinary retention; osteoporosis; angina pectoris; myocardial infarction; ulcers; asthma; allergies; benign prostatic hypertrophy; and psychotic and neurological disorders, including anxiety, schizophrenia, manic depression, delirium dementia, severe mental retardation and dyskinesias, such as Huntington's disease or Gilles dela Tourett's syndrome, among others and diagnostic assays for such conditions. Excerpt(s): This invention relates to newly identified polynucleotides, polypeptides encoded by them and to the use of such polynucleotides and polypeptides, and to their production. More particularly, the polynucleotides and polypeptides of the present invention relate to a G-protein coupled 7-transrembrane receptor, hereinafter referred to as human neurotensin type 2. The invention also relates to inhibiting or activating the action of such polynucleotides and polypeptides. It is well established that many medically significant biological processes are mediated by proteins participating in signal transduction pathways that involve G-proteins and/or second messengers, e.g., cAMP (Lefkowitz, Nature, 1991, 351:353-354). These proteins are herein referred to as proteins participating in pathways with G-proteins or PPG proteins. Some examples of these proteins include the GPC receptors, such as those for adrenergic agents and doparnine (Kobilka, B. K., et al., Proc. Natl Acad. Sci., USA, 1987, 84:46-50; Kobilka, B. K., et al., Science, 1987, 238:650-656; Bunzow, J. R., et al., Nature, 1988, 336:783-787), Gproteins themselves, effector proteins, e.g., phospholipase C, adenyl cyclase, and phosphodiesterase, and actuator proteins, e.g., protein kinase A and protein kinase C (Simon, M. I., et al., Science, 1991, 252:802-8). For exarnple, in one form of signal transduction, the effect of hormone binding is activation of the enzyme, adenylate cyclase, inside the cell. Enzyme activation by hormones is dependent on the presence of the nucleotide GTP. GTP also influences hormone binding. A G-protein connects the hormone receptor to adenylate cyclase. G-protein was shown to exchange GTP for bound GDP when activated by a hormone receptor. The GTP carrying form then binds to activated adenylate cyclase. Hydrolysis of GTP to GDP, catalyzed by the G-protein itself, returns the G-protein to its basal inactive form Thus, the G-protein serves a dual role, as an intermediate that relays the signal from receptor to effector, and as a clock that controls the duration of the signal. Web site: http://www.delphion.com/details?pn=US06008050__

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Patent Applications on Delirium As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to delirium: •

Methods for treating delirium glucocorticoid receptor- specific antagonists Inventor(s): Belanoff, Joseph K.; (Woodside, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20040029848 Date filed: May 12, 2003 Abstract: This invention generally pertains to the field of psychiatry. In particular, this invention pertains to the discovery that agents which inhibit the binding of cortisol to its receptors can be used in methods for treating delirium. Mifepristone, a potent specific glucocorticoid receptor antagonist, can be used in these methods. The invention also provides a kit for treating delirium in a human including a glucocorticoid receptor antagonist and instructional material teaching the indications, dosage and schedule of administration of the glucocorticoid receptor antagonist. Excerpt(s): This application claims the benefit of provisional application No. 60/288,619, filed May 4, 2001. This invention generally pertains to the field of psychiatry. In particular, this invention pertains to the discovery that agents that inhibit the binding of cortisol to the glucocorticoid receptor can be used in methods of treating delirium. Delirium is a disturbance in consciousness that typically results from an underlying physical condition. Patients suffering from delirium display changes in cognition (such as memory deficits, disorientation, and language or perceptual disturbances) that develop over a short period of time and tend to fluctuate during the course of the day. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with delirium, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “delirium” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on delirium. You can also use this procedure to view pending patent applications concerning delirium. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above. 9

This has been a common practice outside the United States prior to December 2000.

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CHAPTER 6. BOOKS ON DELIRIUM Overview This chapter provides bibliographic book references relating to delirium. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on delirium include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “delirium” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on delirium: •

Looking at Confusion: A Handbook for Those Working With the Elderly Source: Bicester, England: Winslow Press. 1987. 66 p. Contact: Available from Speech Bin, Inc. 1766 Twentieth Avenue, Vero Beach, FL 32960. (407) 770-0007. PRICE: $22.50 plus 10 percent shipping and handling. ISBN: 0863880606. Summary: Directed toward caregiver staff working with the elderly, this book presents a logical way of looking at and understanding the many facets of dementias and provides ideas for training programs. Individual chapters address the following topics: confusion, delirium, depression, odd behavior, the spiral or danger period of dementia, 'hardening of the arteries,' diseases associated with dementia, and Alzheimer's disease. The chapter on Alzheimer's disease focuses on three topics: 1) the differences between it and senile dementia; 2) the causes of the disease; and 3) typical behavior. Discussion topics and exercises are listed, usually at the beginning of a chapter. 10 references.

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Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th Ed Source: Washington, DC: American Psychiatric Association. 1994. 886 p. Contact: American Psychiatric Association. 1400 K Street, NW, Washington DC 20005. (800) 368-5777. PRICE: $54.95. ISBN: 0890420610. Summary: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), was created to help clinicians make diagnoses of mental disorders, aid in facilitating communication among clinicians and researchers, and improve the collection of clinical information; it is designed to serve as an educational tool for teaching psychopathology as well. The manual begins with instructions concerning its use, followed by the DSM-IV Classification, which provides a systematic list of the official codes and categories. Next is a description of the DSM-IV multiaxial system for diagnosis, followed by the diagnostic criteria for each of the DSM-IV disorders accompanied by descriptive text. The DSM-IV disorders are grouped into 16 major diagnostic classes in addition to 1 area called 'other conditions that may be a focus of clinical attention.' The disorders in the dementia section are characterized by the development of multiple cognitive deficits (including memory impairment) that are due to the direct physiological effects of a general medical condition, to the persisting effects of a substance, or to multiple etiologies (e.g., the combined effects of cerebrovascular disease and Alzheimer's disease). The dementia section, also including delirium, amnestic, and other cognitive disorders, provides the following information: (1) generalized definitions of each type of disorder; (2) diagnostic features; (3) associated features and disorders; (4) specific culture, age, and gender features; (5) prevalence; (6) course; and (7) differential diagnosis. Guidelines for properly recording the diagnosis also are provided. The manual includes 10 appendixes.

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Differential Assessment of Dementia and Depression in Elderly People Source: in Safford, F.; Krell, G.I., eds. Gerontology for Health Professionals: A Practical Guide. 2nd ed. Washington, DC: National Association of Social Workers. 1997. p. 56-73. Contact: National Association of Social Workers. PO Box 431, Annapolis Junction, MD 20701-0431. (800) 227-3590. PRICE: $24.95. ISBN: 0871012839. Summary: This book chapter is intended to guide health care providers in the differential diagnosis of dementia and depression in older people. It reviews obstacles to an accurate diagnosis and presents definitions of dementia, delirium, and depression. It outlines the cognitive, psychological, and behavioral symptoms of mental impairment and describes some of the assessment tools that may be useful in screening for dementia. It suggests an approach to collecting the types of information needed to make an accurate diagnosis, and compares some of the main features of dementia and depression to aid in the differentiation of the two disorders. A section on the assessment of depression focuses on the symptoms of depression that are more commonly seen in older patients, questions to ask during assessment, classification of types of depression, and some of the medical conditions and drugs that may cause depression. The chapter concludes with a discussion of issues in the treatment of dementia and depression in older patients.

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Mental Health Problems and Older Adults Source: Santa Barbara, CA: ABC-CLIO, Inc. 1990. 300 p. Contact: Available from ABC-CLIO. 130 Cremona Drive, P.O. Box 1911, Santa Barbara, CA 93116-1911. (805) 968-1911 or (800) 422-2546. ISBN: 0874362407. PRICE: $39.50.

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Summary: This book describes the mental health problems of older adults and provides a list of resources and references for additional information. Part One includes chapters on mood disorders, cognitive problems, other mental health problems, and the mental health system. The chapter on cognitive problems includes a section on abnormal changes in the brain, such as Alzheimer's disease or other dementias and delirium. The section covers definitions of cognitive problems, frequency, causes, evaluation, treatment, and outcome.Part Two covers resources, including a chapter on national, state, and local resources and a chapter on reference materials (books, pamphlets, films, and video cassettes). •

Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment Source: New York, NY: The Guilford Press. 1998. 418 p. Contact: Available from Guilford Publications. 72 Spring Street, New York, NY 10012. (800) 365-7006, (212) 431-9800; FAX: (212) 966-6708. Internet: http://www.guilford.com. PRICE: $40.00. ISBN: 1572303689. Catalog number: 0368. Summary: This book discusses the assessment and treatment of mental disorders in older adults. Fourteen chapters discuss the following topics: mental health concepts and practice with older adults; normal processes of aging; dementia, delirium, and other cognitive problems in old age; functional disorders in later life; clinical assessment; psychological testing for differential diagnosis and competence evaluations; basic issues in treatment; treatment of depression; coordination of mental health and aging services; paranoid disorders; treatment of dementia; family caregiving; consultation in institutional settings; and ethical issues in geriatric psychology. The chapter on treatment of dementia includes information about medications, cognitive stimulation, behavioral interventions, and counseling patients with dementia.

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Caring for People With Problem Behaviours: A Basic, Practical Text for Nurses, Health Workers and Others Who Are Learning to Manage Difficult Behaviours. A Self-Instructional Learning-Teaching Package Source: Melbourne, Australia: Ausmed Publications. 1999. 203 p. Contact: Available in U.S. from Ausmed Publications in care of Jamco Distribution, 1401 Lakeway Drive, Lewisville, TX 75057. Tel: (800) 538-1287; FAX: (972) 353-1300. Website: www.ausmed.com.au. PRICE: $39.95 (paperback). ISBN: 0958717168. Summary: This book is a self-instructional guide to caring for people with behavior problems, including those with dementia. Chapter 1 provides background information about understanding human behavior. Chapters 2 through 6 describe the Solutionfocused Behavioral Change model for managing difficult behaviors and apply the model to specific populations, including people with anxiety, aggressive behaviors, depression, and mental illness. The final chapter addresses the management of behavior problems in people with confusion. This chapter discusses the differences between delirium and dementia, assessment and intervention for the two disorders, strategies for specific behaviors, and community care options. Each chapter includes learning objectives, chapter references, instructional material, and written learning activities. The book also has a pre-test to assess prior knowledge about the management of behavior problems, a post-test to complete after reading the book, test answers, and a glossary.

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Quality Care in the Nursing Home Source: St. Louis, MO: Mosby Lifeline. 1997. 576 p.

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Contact: Available from Mosby-Lifeline. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 667-2968. Internet access: http:/www.mosby.com. PRICE: $49.95. ISBN: 0815142226. Summary: This book is designed as a guide to nursing care practices, policies, and procedures in a geriatric, chronic care setting. The treatment protocols presented build on the assessment and care-planning strategies of the Minimum Data Set and Resident Protocols set forth by the Health Care Finance Administration. Chapters are organized under three broad categories: assessment, geriatric symptoms, and therapeutic approaches. Some of the topics include sleep disorders, Parkinson's disease, cognitive loss, delirium, behavioral symptoms, depression, falls, incontinence, activities of daily living, rehabilitation, restraint reduction, and terminal care. •

Primary Care Physician's Guide to Common Psychiatric and Neurologic Problems: Advice on Evaluation and Treatment from Johns Hopkins Source: Baltimore, MD: Johns Hopkins University Press. 2001. 236 p. Contact: Johns Hopkins University Press. 2715 North Charles Street. Baltimore, MD 21218-4363. (800) 537-5487 or (410) 516-6900. FAX: (410) 516-6998. Website: www.press.jhu.edu. PRICE: $55.00 (hardcover); $19.95 (paperback). ISBN: 0801865530 (hardcover); 0801865549 (paperback). Summary: This book is designed to help primary care physicians recognize, evaluate, and treat common psychiatric and neurologic disorders in patients with medical illness. It has 12 problem-focused chapters, each written by a specialist who is experienced in consulting with primary care physicians. The complaints discussed are sadness, nervousness, forgetfulness, unrealistic concerns about health, suicidal thoughts, alcoholism and drug dependence, weakness, numbness, back pain, headaches, dizziness, and tremor. Two additional chapters explain the screening evaluations for psychiatric and neurologic disorders. The chapter on forgetfulness discusses the assessment and treatment of the three main causes of cognitive impairment: delirium, dementia, and focal syndromes.

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Aging and Neuropsychological Assessment Source: New York, NY: Plenum Press. 1992. 369 p. Contact: Plenum Press. 233 Spring Street New York, NY 10013-1578. (800) 221-9369. PRICE: $45.00. ISBN: 0306440628. Summary: This book is designed to provide an introduction to the neuropsychological aspects of aging and some of the prominent neuropsychiatric disorders of later life. The book reviews changes in the brain and behavior that occur in later life and contains guidelines to the psychological assessment of older patients. Specific tests and techniques are described, recommendations are made for interpretation, and case examples are summarized to demonstrate the application of different techniques. The first section of the book examines normal aging with an overview of normal changes in the aging brain and cognitive developments, clinical neuropsychological measures for older adults, and guidelines for interpreting neuropsychological test results. The second portion of the book discusses common neuropsychiatric conditions. These chapters review the clinical syndromes of delirium and dementia, Alzheimer's disease, Parkinson's disease, and vascular dementia. This section also includes case examples of individuals with dementing disorders and a review of depression. References included.

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Geropsychiatric Nursing. Second Edition Source: St. Louis, MO: Mosby. 1995. 420 p. Contact: Available from Mosby. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545; FAX: (800) 535-9935. Internet: http://www.mosby.com. PRICE: $37.95. ISBN: 0801678110. Summary: This book is designed to teach nurses about the care of older people with mental health and emotional problems. Chapters address the following topics: overview of mental health and older adults; promotion of mental health in older adults; government, financial, and human resources; assessment; psychotropic drugs; depression, suicide, and bereavement; delirium, dementia, and other cognitive disorders; schizophrenia, paranoia, anxiety, and somatoform disorders; substancerelated disorders; inpatient geropsychiatric nursing in a general hospital; mental and behavioral problems in the nursing home; care of the mentally ill older person in the home; and community programs. Chapter seven includes information on the diagnosis of dementia, potentially reversible causes of dementia, Alzheimer's disease and other irreversible dementias, and vascular dementia. The book has a bibliography and eight appendices.

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Coping With Alzheimer's Disease and Other Dementing Illnesses Source: San Diego, CA: Singular Publishing Group, Inc. 1993. 296 p. Contact: Available from Singular Publishing Group, Inc. 4284 41st Street, San Diego, CA 92105-1197. (800) 521-8545. PRICE: $16.95 plus $5.00 shipping and handling; book code number 0401. ISBN: 1565930975. Summary: This book offers practical advice and information to help families cope with Alzheimer's disease and related dementias. The first five chapters discuss current medical knowledge about Alzheimer's disease and related dementias, including normal and abnormal memory changes in aging, causes and symptoms of delirium and dementia, the medical evaluation process, and causes and stages of Alzheimer's disease. The next six chapters provide practical suggestions for managing and coping with everyday tasks, personal hygiene, social and leisure activities, safety issues, and disease related emotional and behavioral changes. The remaining chapters address such issues as communicating with persons who have dementia, developing coping strategies, financial and legal planning, ongoing medical care, enlisting support for home care, relocation to a residential facility, nursing home placement, and issues in the terminal stage of illness.

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Practical Psychiatry in the Nursing Home: A Handbook for Staff Source: Kirkland, WA: Hogrefe and Huber. 1992. 284 p. Contact: Available from Hogrefe and Huber Publishers. P.O. Box 2487, Kirkland, Washington 98083. (206) 820-1500. (800) 228-3749. PRICE: $34.50 plus $3.50 shipping and handling. ISBN: 0880370427. Summary: This book was written to help staff members in long term care facilities to manage the behavioral and psychiatric problems of elderly residents, including those with Alzheimer's disease. The book is aimed at all staff members including nurses, nursing aides, physicians, social workers, psychologists, occupational therapists and others. Particularly relevant to Alzheimer's disease are chapters on dementia, behavioral management strategies, understanding and helping the family, and legal and ethical

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issues in long term care. There are also pertinent chapters dealing with the Mental Status Examination, delirium, depression, suspiciousness, geriatric psychopharmacology, and psychotherapy. The book uses clinical case examples, with an emphasis on practical management strategies. It responds specifically to questions that are often asked by long term care staff, and each chapter concludes with key points. References are included in each chapter. It is suggested that the book is suitable for both continuing and undergraduate education. •

DSM-IV Sourcebook, Volume 1 Source: Washington, DC: American Psychiatric Association. 1994. 768 p. Contact: American Psychiatric Association. 1400 K Street, NW, Washington DC 20005. (800) 368-5777. PRICE: $125.00. ISBN: 0890420653. Summary: This book, the first of five volumes, contains literature reviews of research on mental disorders and summarizes the DSM-IV Work Group efforts that led to the publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV). This volume presents a multi-chapter section (Section II) on delirium, dementia, and amnestic and other cognitive disorders, among other disorders. Topics in the dementia section include accurately diagnosing dementia, estimating its severity, monitoring its course, and the reliability and validity of the DSM-III-R criteria in light of methods used to operationalize these criteria. Other standard antemortem clinical diagnostic criteria for dementia also are discussed. Section II provides an executive summary and an overview of the activities and procedures of the DSM-IV Work Group, including subclassification of these disorders and two new proposed categories: mild neurocognitive disorders and aging-associated memory decline.

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Alzheimer's Disease: A Scientific Guide for Health Practitioners Source: Bethesda, MD: National Institutes of Health. 1984. 22 p. Contact: Available from National Institute of Neurological and Communicative Disorders and Stroke. Office of Scientific and Health Reports, National Institutes of Health, Bethesda, MD 20205. NIH Publication Number 84-2251. Summary: This brief guide provides basic information for health practitioners on the nature and course of Alzheimer's disease. The guide discusses terminology, the pathology of Alzheimer's disease, possible causes of the disease, diagnosis and some simple office tests, treatment possibilities, and dealing with a patient in the family. A chart delineates reversible causes of mental impairment which result in dementia or delirium.

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Guide to the Understanding of Alzheimer's Disease and Related Disorders Source: New York, NY: New York University Press. 1987. 192 p. Contact: Available from New York University Press. New York, NY. PRICE: $32.00. ISBN: 0814741703. Summary: This guide reviews current knowledge on dementias for health care practitioners. The book examines the impact of senile dementia on society and family members, along with a look at the size of the problem in various countries. Other topics include brain changes and cognitive deficits of dementias; theories on the origins of Alzheimer's disease; diagnosis and prevention of multi-infarct dementia; the causes and

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features of depression and delirium in elderly people; and community and institutional care of people with dementia (focusing on the British experience). Drug treatments and psychological interventions are also described. A bibliography is included. •

Concise Guide to Geriatric Psychiatry. 2nd ed Source: Washington, DC: American Psychiatric Press, Inc. 1997. 326 p. Contact: American Psychiatric Press, Inc. 1400 K Street, NW, Washington, DC 20005. (800) 368-5777; (202) 682-6262. Internet access: http://www.appi.org. PRICE: $21.00. ISBN: 0880487968. Order Number: INET8796. Summary: This handbook is intended to assist geriatric psychiatrists in the diagnosis and treatment of mental disorders that often are seen in later life. The book provides background information about contemporary issues in aging and health care, barriers to geriatric mental health care, and strategies for working effectively with older patients. It includes an overview of the process of normal aging and the cognitive, personality, and physical changes that occur as people age. It discusses the diagnosis and treatment of major depression and bipolar mood disorder, Alzheimer's disease (AD) and other dementias, delirium, anxiety disorders, late-onset psychosis, sleep disorders, substance abuse, sexual dysfunction, and other psychiatric illnesses. The chapter on AD discusses the diagnosis, epidemiology, clinical presentation, pathogenesis, diagnostic criteria, clinical evaluation, and treatment. An appendix includes various clinical assessment instruments with scoring instructions or ordering information.

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Impact of Psychotropic Drugs on Health and Nutritional Status Source: Chilton, WI: Kobriger Presents, Inc. 1999. 158 p. Contact: Available from Kobriger Presents, Inc. PO Box 55, Chilton, WI 53014. (888) 6874806, (920) 849-7806; FAX: (920) 849-3904. Internet: http://www.kobriger.com. PRICE: $99.95 plus $9.95 shipping. Summary: This manual, intended for nutrition professionals, addresses psychotropic drug use and the nutritional status of patients, primarily in the elderly long-term care population. Chapters include psychotropic drug use in long-term care and clinical practice, the brain and the nervous system, neurotransmitters and the effect of aging, delirium and depression, psychosocial well-being and anxiety, dementia and Alzheimer's disease, behavioral symptoms, and anti- Parkinson's and anti-seizure drugs. Includes a resident assessment screening form and bibliography.

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Central Nervous System Complications in AIDS Source: Working With AIDS: A Resource Guide for Mental Health Professionals. Contact: University of California San Francisco, AIDS Health Project, PO Box 0884, San Francisco, CA, 94143-0884, (415) 476-6430. Summary: This overview of mental status changes resulting from central nervous system complications in AIDS focuses on the need to differentiate delirium from depression or dementia and to use appropriate treatment interventions. All three conditions have overlapping symptoms. A delirium usually occurs in a few hours to a few days. If clinicians can rule out a treatable delirium or focal lesion they should next differentiate between a functional depression and dementia. To distinguish between depression and a medical etiology, consultants should emphasize cognitive and affective symptoms and minimize physical concerns. The unexplained onset of

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depression in AIDS patients who have otherwise been coping adequately may indicate the onset of a central nervous system process such as dementia. Treatment may include medication and various interpersonal therapy techniques. Supports for caregivers are also needed. The goals of these interventions are to maintain people at their highest levels of adaptive functioning and to maintain their autonomy, personal integrity, and independence while trying to diagnose and treat any psychological processes. •

Geriatrics at Your Fingertips Source: New York, NY: American Geriatrics Society. 2000. 190 p. Contact: Available from Kendall Hunt Publishing Company. 4050 Westmark Drive, PO Box 1840, Dubuque, IA 52004-1840. (800) 338-8290, (319) 589- 1000. Internet: http://www.kendallhunt.com. PRICE: $10.95 plus $2.50 shipping and handling. ISBN: 444019480. LC number: 99-75691. Summary: This pocket-sized geriatrics reference book has chapters on dementia, delirium, and depression in older adults. The chapter on dementia includes information about the definition of dementia, estimated frequencies of different types of dementia, the diagnosis of Alzheimer's disease (AD), the different stages of AD, noncognitive symptoms, risk and protective factors for AD, evaluation, nonpharmacologic and pharmacologic treatment approaches, and caregiver issues. The chapter on delirium discusses diagnosis, potential causes, and management strategies. The chapter on depression focuses on evaluation and treatment with nonpharmacologic and pharmacologic approaches and electroconvulsant therapy; it includes tables listing antidepressants used for older adults and antidepressants to avoid in older adults. Includes index.

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Neuropsychiatry of HIV for Primary Care Providers Contact: New York University, School of Education Health Nursing and Arts Professions, Department of Health Studies, AIDS/SIDA Mental Hygiene Project, 35 W 4th St Ste 1200, New York, NY, 10012, (212) 998-5614. Summary: This revised training guide educates primary care providers on the neuropsychiatry of HIV infection in order that they may provide competent care to people with HIV. Diagnosis and management of neuropsychiatric aspects of HIV infection are becoming more important to primary care physicians as patients are living longer and being treated for increasing periods of time on an ambulatory basis. At some point during the course of the illness, the majority of patients will have a psychiatric disorder related to HIV, and direct impairment of brain function caused by the virus. Primary care physicians need proficiency in differential diagnosis of cognitive, affective, and behavior dysfunction, appropriate referral to neurologists and psychiatrists, helping patients deal with being informed of the diagnosis, and using the doctor-patient relationship to help the patient cope with uncertainty about the onset and progression of symptoms. The training guide is organized as follows: psychiatric skills review; diagnosis and treatment of AIDS dementia complex and delirium; diagnosis and treatment of functional psychiatric disorders; psychiatric aspects of pain in HIV/AIDS; and case studies.

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Neuropsychiatric Complications of AIDS: Instructor's Guide Contact: University of California Los Angeles, School of Medicine, Center for Health Sciences, Division of General Internal Medicine and Health, Services Research, B-558 Factor Bldg, 10833 Le Conte Ave, Los Angeles, CA, 90024-1685, (310) 206-8531.

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Summary: This teaching guide, which can be used in conjunction with videorecording AD0006405 as an educational module, addresses neuropsychiatric complications in persons infected with Human immunodeficiency virus (HIV) and in Persons with AIDS (PWA's). It focuses on diagnosis and patient management of neuropsychiatric disorders from psychosocial and psychiatric perspectives. It describes the psychosocial concepts important to the care of PWA's and compares Acquired immunodeficiency syndrome (AIDS) with other life-threatening illnesses, such as cancer. The teaching module discusses psychosocial stresses for PWA's, functional psychiatric problems such as depression and adjustment disorders, neuropsychiatric disorders such as dementia and delirium, and local neurological disorders. Text for 38 slides is included in the guide, which is accompanied by pre-test and post-test questionaires.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “delirium” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “delirium” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “delirium” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Practice Guideline for the Treatment of Patients with Delirium (Includes Treating Delirium: A Quick Reference Guide for Psychiatrists) by American Psychiatric Association; ISBN: 089042313X; http://www.amazon.com/exec/obidos/ASIN/089042313X/icongroupinterna

Chapters on Delirium In order to find chapters that specifically relate to delirium, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and delirium using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “delirium” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on delirium: •

Dementia and Delirium Source: in Rowe, J.W. and Besdine, R.W., eds. Geriatric Medicine, 2nd ed. Boston, MA: Little, Brown and Company. 1988. p. 375-401. Contact: Available from Little, Brown and Company. 34 Beacon Street, Boston, MA 02106. (617) 227-0730. PRICE: $95.00. ISBN: 0316759694. Summary: After mention of intellectual changes of normal aging, this chapter considers global cognitive disturbances of older persons (dementia and delirium), primarily from clinical and biologic perspectives, with brief observations on the social aspects of the

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disorders. Specific attention is given to the definitions of dementia and delirium; the epidemiology, clinical characteristics, detection, evaluation, and causes of reversible and irreversible dementias (Alzheimer's disease, multi-infarct dementia and other dementias) in older people; the cost of dementia care; the detection, epidemiology, course, outcome, causes, pathophysiology, and drug therapy of delirium. This report gives major attention to the diagnosis, clinical features, relation to depression, pathology, neurochemistry, genetics, cause, management strategies, and specific treatments (cholinergic repletion; ergoloid mesylate drugs, monoamine oxidase inhibitors) of Alzheimer's disease. Detailed information is included concerning specific reversible and irreversible causes of organic mental disorders in the elderly, cases of depression presenting as pseudodementia, and drugs associated with delirium in the elderly. 148 references. •

Delirium, Dementia, and Amnestic Disorders Source: in Hales, R.E.; Yudofsky, S.C.; Talbott, J.A., eds. American Psychiatric Press Textbook of Psychiatry. 2nd ed. Washington, DC: American Psychiatric Press, Inc. 1994. p. 311-354. Contact: American Psychiatric Press, Inc. 1400 K Street, NW, Washington, DC 20005. (202) 682-6262; FAX (202) 789-2648. PRICE: $165.00 plus $7.50 shipping. Internet access: http:/www.appi.org. ISBN: 0880483881. Summary: This chapter discusses epidemiology, clinical features, differential diagnosis, prognosis, and treatment of delirium, dementia, and amnestic disorders. Some scientists categorize dementias by distinguishing between cortical and subcortical types. The cortical dementias, of which Alzheimer's disease is the most common example, reflect dysfunction of the cerebral cortex. The subcortial dementias are caused by disfunctions in deep gray and deep white matter structures. A table lists the diagnostic criteria from the 'Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.' The chapter also reviews other types of dementia resulting from disease or trauma. According to the authors, comfort in diagnosis, management, and treatment, when possible, is a necessity for the psychiatrist. 19 tables, 7 figures, 272 references.

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Delirium and Dementia Source: in Rowland, L.P., ed. Merrit's Textbook of Neurology, 8th ed. Philadelphia, PA: Lea and Febiger. 1989. p. 3-9. Contact: Available from Williams and Wilkins. 428 East Preston Street, Baltimore, MD 21202. (800) 992-0483. PRICE: $76.00. ISBN: 0812111486. Summary: This chapter discusses the characteristics and differences of two principal symptoms of neurologic disorders, delirium and dementia. Delirium, an acute confusional state due to various causes, is treatable. Dementia, in contrast, is usually chronic and progressive, usually caused by degenerative diseases of the brain or by multiple strokes. The main difference is that delirium is manifested by a fluctuating state of consciousness, while dementia patients are usually alert and aware until late in the course of the disease. Particular attention is given to causes, diagnosis and treatment of delirium, and the characteristics and differential diagnosis of dementia. A mental status test for dementia and a tabulation of diseases that cause dementia are included (including Alzheimer's disease). 15 References.

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Organic Brain Syndromes Presenting With Global Cognitive Impairment: Delirium and Dementia Source: in Winokur, G. and Clayton, P., eds. Medical Basis of Psychiatry. Philadelphia, PA: W.B. Saunders Company. 1986. p. 3-19. Contact: Available from W.B. Saunders Company. West Washington Square, Philadelphia, PA 19105. (800) 545-2522. PRICE: $69.00. ISBN: 0721613063. Summary: This chapter examines two types of organic brain disturbances in detail: delirium and dementia. Aspects of delirium discussed include its definition, etiology, pathogenesis, epidemiology, pathology, clinical presentation, clinical course, laboratory findings, differential diagnosis, and treatment. Aspects of dementia include its definition, the etiology and pathogenesis of different types of dementia (primary degenerative; multi-infarct; other), the epidemiology of each of the various dementia types, the pathology of each these types, clinical features, clinical course, laboratory findings, differential diagnosis, and treatment. 66 references.

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Confusion, Dementia, and Delirium Source: in Ham, R.J.; Sloane, P.D. Primary Care Geriatrics: A Case-Based Approach. 2nd ed. St. Louis, MO: Mosby-Year Book, Inc. 1992. p. 259-312. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, P.O. Box 46908, St. Louis, MO 63146-9934. (800) 426-4545 or FAX (314) 872-8370. PRICE: $59.00. Summary: This textbook chapter focuses on the distinct clinical features of delirium and dementia and the appropriate diagnostic and management plans that should be implemented in treating the various disorders, including Alzheimer's disease, that fall under these broad categories. Techniques and approaches described help health professionals assess individual cases; emphasis is on giving patients as much autonomy as possible and preventing further decline, if possible. A problem-solving team approach that includes the patient and his or her family as well as several health care professionals is suggested. Applying this approach to different settings, such as home, office, hospital, and nursing home, is discussed. Real case histories are integrated into the text. 61 references.

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CHAPTER 7. MULTIMEDIA ON DELIRIUM Overview In this chapter, we show you how to keep current on multimedia sources of information on delirium. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on delirium is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “delirium” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “delirium” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on delirium: •

Neuropsychiatric Complications of AIDS Contact: University of California Los Angeles, School of Medicine, Center for Health Sciences, Division of General Internal Medicine and Health, Services Research, B-558 Factor Bldg, 10833 Le Conte Ave, Los Angeles, CA, 90024-1685, (310) 206-8531. Summary: In this videorecording, designed as a training program lecture, a physician discusses the neuropsychiatric complications of Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS), emphasizing the disease's morbidity rate, its clinical complications, and its effect on the central nervous system. Physicians should be aware of the dimensions of the disease and its impact on various aspects of the patient's life. Psychosocial factors such as stress factors, coping behavior, and patient support systems will impact on functional psychiatric problems, the most significant of which, in AIDS patients, are dementia and delirium. Cognitive impairment, manifested in loss of motor coordination, language, and memory, is symptomatic of these conditions, which can be caused by viral infections. While in some cases, azidothymidine (AZT) has slowed or reversed dementia, physicians involved in

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patient management must still consider the implications of such impairment. An Instructor's Guide (see record AD0006406) has been developed for use with this videorecording as an educational module. •

Common Psychiatric Disorders in the Elderly Home Health Patient Source: Tuscaloosa, AL: Dementia Education and Training Program. 1993. (videocassette). Contact: Alabama Department of Public Health. Bureau of Geriatric Psychology. Dementia Education and Training Program. 200 University Boulevard, Tuscaloosa, AL 35401. (800) 457-5679; (205) 759-0820; FAX (205) 759-0891. PRICE: $15.00. Summary: In this videotape, Dr. R. Powers describes the identification and management of two of the most common psychiatric disorders in older people: depression and delirium. Topics include the most common causes, incidence, risk factors, onset, nursing assessments, and clinical signs of delirium. Dr. Powers also discusses depression in terms of its incidence, etiology, basic and special symptoms, differential diagnosis, treatment, and the risk of suicide. Although this is one of a series of videotapes directed to home health nurses, the content may be useful to a variety of health professionals.

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Managing and Understanding Behavior Problems in Alzheimer's Disease and Related Disorders Source: Seattle, WA: University of Washington Alzheimer's Disease Center. 1991. (videocassette). Contact: Northwest Geriatric Education Center, University of Washington, HL-23, Seattle, WA. 98195. (206) 685-7478. PRICE: $250.00 (includes 10 videotapes, written manual, shipping and handling. Washington State residents add 8.2 percent sales tax). Summary: This training kit includes 10 videotapes and a written manual geared toward institutional staff, such as nurses and nurses aides, as well as toward families and home health aides responsible for the daily care of a dementia patient. The program provides background information about Alzheimer's disease and other dementias, teaches skills necessary to assess and modify behavior problems, and identifies and addresses the needs of caregivers. Caregivers learn the ABC (antecedent/behavior/consequence) approach to understanding behaviors and designing a plan for change. Titles of the videotapes are: "Overview Part I: Alzheimer's Disease and Related Diseases," "Overview Part II: Delirium and Depression," " ABCs: An Introduction," "Managing Aggressive Behaviors: Anger and Irritation, Catastrophic Reactions," "Managing Psychotic Behaviors: Language Deficits," "Managing Psychotic Behaviors: Hallucinations/Delusions and Paranoia and Suspiciousness," "Managing Personal Hygiene: Bathing and Dressing," "Managing Difficult Behaviors: Wandering and Inappropriate Sexual Behaviors," "Managing Difficult Behaviors: Depression," and " Caregiver Issues.".

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Learning to Care: An Introduction to HIV Psychiatry Contact: Canadian Public Health Association, Canadian HIV/AIDS Clearinghouse, 4001565 Carling Ave Ste 400, Ottawa, (613) 725-3434, http://www.cpha.ca. Canadian Psychiatric Association, 260-441 MacLaren St, Ottawa, http://cpa.medical.org. Summary: This video, for mental health professionals, examines treating individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) for psychiatric disorders. The objectives of the video are to review the basic

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principles of psychiatric intervention with individuals living with HIV/AIDS, including drug therapy and psychotherapy strategies; to build on the viewer's existing knowledge; and to suggest ways of augmenting specific learning. The video features four patients affected by HIV/AIDS to illustrate how common psychiatric disorders and their treatment differ compared to regular psychiatric patients. It covers anxiety disorder, mood disorder, mania/bipolar disorders, psychosis, delirium, cognitive/motor disorders, and bereavement. It provides suggestions for specific psychotherapy and medications for each disorder. •

Neuropsychiatric Aspects of HIV/AIDS Contact: University of Washington, Northwest AIDS Education and Training Center, 901 Boren Ave Ste 1100, Seattle, WA, 98104-3596, (800) 677-4799, http://depts.washington.edu/nwaetc/. Summary: This videorecording is a lecture by Dr. Terence C. Gayle, a clinical assistant professor at the University of Washington/Harborview Medical Center. Aimed at firstyear residents in psychiatry, it covers neuropsychological disorders commonly found in Human immunodeficiency virus (HIV) disease. He begins his lecture by discussing the epidemiology of Acquired immunodeficiency syndrome (AIDS). He then examines, in detail, the three types of neurological disorders: Organic problems such as delirium and dementia, psychoses, and mood disorders such as mania and major depression. The majority of the lecture focuses on AIDS Dementia Commplex, with detailed information on early and late stage signs and symptoms, possible causes, and types of treatment. He delves into the ethical dilemmas of caring for a patient who has a pressing need for treatment, but may die soon. Gayle then goes on to take less detailed looks at psychoses and depression.

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Survival of the Delirious Source: Video Against AIDS; 1. Contact: Video Data Bank, 22 Warren St, New York, NY, 10007, (212) 233-3441. Chicago Art Institute School, 280 S Columbus Dr, Chicago, IL, 60603, (773) 443-3793. V Tape, 401 Richmond Street West, Toronto, (416) 351-1317. Summary: This videorecording presents the epidemic of Acquired immunodeficiency syndrome (AIDS), caused by the Human immunodeficiency virus (HIV), in terms of the Native American myth of Windigo, the destroyer giant who stalks the northern forest and tundra, bringing disaster, delirium, and madness. Scenes of doctors conferring with homosexual patients about AIDS tests and treatment are interspersed with narration of the Windigo legend, accompanied by the steady beating of a Native American drum.

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Problem Behaviors in Geriatrics: Agitation and Restlessness Source: Indianapolis, IN: Geriatric Video Productions. 1996. Contact: Available from Geriatric Video Productions. PO Box 55741, Indianapolis, IN 46205. (800) 621-9181; FAX: (317) 579-0402. Internet: http://www.geriatricvideo.com. PRICE: $139.00 plus $2.00 shipping and handling. Summary: This videotape is intended to help nursing home staff identify and manage agitated and restless behavior in elderly people. The narrator defines agitation and describes the four ways in which it can manifest itself: psychomotor activity, such as pacing, wandering, and accelerated movements; physiological disturbances, such as incontinence and refusal of food; speech patterns, such as yelling and repeated

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vocalizations; and social behaviors, such as hitting and biting. Agitation may be the result of internal or external stimuli or a medical disorder, such as delirium, dementia, or depression. The narrator discusses how to prevent or reduce different types of agitation, focusing on staff-patient interaction, environmental design, and other nonrestrictive techniques. If non-restrictive techniques are unsuccessful in controlling agitation, medication may be added to the treatment plan. The narrator discusses conditions under which medications should be given and provides information on antipsychotic agents, long-acting benzodiazepines, and short-acting benzodiazepines. A 21-page manual accompanies the video.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “delirium” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on delirium: •

Plenary Presentation Sessions on AIDS Update. The Second International Lesbian and Gay Health Conference and AIDS Forum, Boston, MA, July 20-26, 1988 Contact: Audio Video Transcripts, 250 W 49th St, New York, NY, 10019, (212) 586-1972. Summary: This sound recording of the Second International Lesbian and Gay Health Conference and AIDS Forum, on July 20-26, 1988, in Boston, MA, presents a session on the neuropsychiatric aspects of Acquired immunodeficiency syndrome (AIDS) and Human immunodeficiency virus (HIV) infection. Dr. Marshall Forstein, co-director of an outpatient psychiatric hospital in Cambridge, examines the broad spectrum of concerns, clinical issues, and treatment modalities for the mental illnesses associated with AIDS. The organic basis for behavioral changes, primary infection of HIV in brain tissue, and primary dementing illness are explained in reference to differential diagnosis from delirium, toxoplasmosis and other infections, and drug effects. Compliance; management of pain syndromes; suicide; psychopharmacology, particularly with ritalin; and psychotherapy are also discussed. Dr. David Ostrow, associate professor of psychiatry at the University of Michigan, discusses the natural history of HIV-related brain disease and related ethical problems as evident from a general opinion survey regarding AIDS policies: Employment-based policies, social programs, and mandatory public health policies.

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CHAPTER 8. PERIODICALS AND NEWS ON DELIRIUM Overview In this chapter, we suggest a number of news sources and present various periodicals that cover delirium.

News Services and Press Releases One of the simplest ways of tracking press releases on delirium is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “delirium” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to delirium. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “delirium” (or synonyms). The following was recently listed in this archive for delirium: •

Pathogenesis of cancer-related delirium varies, as does management Source: Reuters Medical News Date: January 01, 2002

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Sedative can cause delirium in elderly Source: Reuters Health eLine Date: December 04, 2001

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Diphenhydramine linked with delirium in elderly in-patients Source: Reuters Medical News Date: December 04, 2001

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Program prevents delirium in elderly patients Source: Reuters Medical News Date: March 04, 1999

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Hospital program cuts delirium episodes Source: Reuters Health eLine Date: March 03, 1999

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AIDS-Related Delirium Underrecognized Source: Reuters Medical News Date: January 20, 1998

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Differential Diagnosis Of Dementia and Delirium Essential Source: Reuters Medical News Date: October 04, 1996

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Interventions Suggested To Avoid Postop Delirium In Elderly Source: Reuters Medical News Date: November 06, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “delirium” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “delirium” (or synonyms). If you know the name of a company that is relevant to delirium, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “delirium” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “delirium” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on delirium: •

Delirium in the Medically Ill Elderly Source: Center for the Study of Aging Newsletter. 12(3): 3, 13.Fall 1990. Contact: Available from University of Pennsylvania, Center for the Study of Aging. 3615 Chestnut Street, Philadelphia, PA 19104-6006. (215) 898-3163 or FAX (215) 898-0580. PRICE: Call for price information. Summary: This newsletter articles examines the etiology and treatment of delirium, which affects approximately twenty percent of older adults hospitalized for medical illness. Delirium is an acute phenomenon that has no confirmed etiology or risk factors. Because it is acute, it should not be confused with chronic diseases like Alzheimer's disease or dementia. Recognition of delirium is essential in order to treat underlying medical illnesses. A rapid change in mental function or sudden confusion indicates the need for an evaluation. Medical disorders associated with delirium include acute infections such as urinary tract infections, pneumonia, or meningitis. Medications that affect the central nervous system such as those for Parkinson's disease and drugs to treat peptic ulcers, hypertension, and cardiovascular disease have also been implicated. People who have Alzheimer's disease appear to be at a greater risk for delirium, although older people without cognitive impairment may develop delirium when in a hospital. A prospective study of medically hospitalized elderly persons found that 16 percent of the patients admitted for acute medical care developed delirium while in the hospital. Researchers hope to use information about the development of delirium to more effectively determine its cause and develop new treatments.

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Academic Periodicals covering Delirium Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to delirium. In addition to these sources, you can search for articles covering delirium that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for delirium. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with delirium. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to delirium: Buspirone •

Systemic - U.S. Brands: BuSpar; BuSpar DIVIDOSE http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202100.html

Clozapine •

Systemic - U.S. Brands: Clozaril http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202157.html

Haloperidol •

Systemic - U.S. Brands: Haldol; Haldol Decanoate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202278.html

Lidocaine •

Topical - U.S. Brands: Lidoderm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500058.html

Olanzapine •

Systemic - U.S. Brands: Zyprexa http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203492.html

Thiamine (Vitamin B 1 ) •

Vitamin B 1 - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Trazodone •

Systemic - U.S. Brands: Desyrel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202573.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “delirium” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 14079 257 208 69 500 15113

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “delirium” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on delirium can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to delirium. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to delirium. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “delirium”:

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Chickenpox http://www.nlm.nih.gov/medlineplus/chickenpox.html Dementia http://www.nlm.nih.gov/medlineplus/dementia.html Neurologic Diseases http://www.nlm.nih.gov/medlineplus/neurologicdiseases.html Parkinson's Disease http://www.nlm.nih.gov/medlineplus/parkinsonsdisease.html Peripheral Nerve Disorders http://www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html Post-Traumatic Stress Disorder http://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html Radiation Exposure http://www.nlm.nih.gov/medlineplus/radiationexposure.html Sinusitis http://www.nlm.nih.gov/medlineplus/sinusitis.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on delirium. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Unmasking AIDS-Related Delirium: Improving Diagnosis and Treatment Contact: University of Washington MedEd Media, Campus Box 359932, Seattle, WA, 98195, (206) 685-9680. Summary: This information package, for health care professionals and the families and friends of individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), provides information on the diagnosis, treatment, and prevention of dementia in HIV/AIDS patients. It describes dementia and examines theories on how and why it occurs in persons with HIV/AIDS; it illustrates and describes the symptoms of dementia in HIV-positive individuals; it reviews the diagnostic and treatment process; it illustrates the benefits of effective delirium

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managment; and it makes recommendations regarding how to prevent dementia in persons with HIV/AIDS. •

HIV Fact Sheet: HIV and Delirium Contact: American Psychiatric Association, AIDS Program Office, 1000 Wilson Blvd, Arlington, VA, 22209-3901, (703) 907-7300, http://www.psych.org/aids. Summary: This information sheet answers questions about delirium. It explains why people with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are vulnerable to delirium. In addition, the information sheet discusses delirium in terms of what it is, what its signs are, what causes it, and how it is diagnosed and treated. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to delirium. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to delirium. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with delirium.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about delirium. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “delirium” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “delirium”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “delirium” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “delirium” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on delirium: •

Basic Guidelines for Delirium Delirium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000740.htm

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Signs & Symptoms for Delirium Agitated Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Agitation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Altered level of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Amnesia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003257.htm

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Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Apathy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Change in mental status Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Hallucinations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm Hypoxia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm Irritability Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003214.htm Lethargic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Lethargy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Restlessness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Stupor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm •

Diagnostics and Tests for Delirium ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm B-12 level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003705.htm

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Blood chemistry Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm Blood gas Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003855.htm Chem-20 Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm Chest X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm CPK Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003503.htm CSF (cerebrospinal fluid) analysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003625.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm Dopamine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003561.htm EEG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003931.htm Glucose test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Head CT scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm Head MRI scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003791.htm Hypercapnia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003469.htm Liver function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Orientation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003326.htm Serum calcium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003477.htm

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Serum electrolytes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm Serum magnesium - test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003487.htm Thyroid function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003444.htm Thyroid stimulating hormone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003684.htm Toxicology screen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm •

Nutrition for Delirium Thiamine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002401.htm

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Surgery and Procedures for Delirium Cataract surgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002957.htm

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Background Topics for Delirium Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Ammonia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002759.htm Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Central nervous system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Electrolyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm

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Precipitate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002275.htm Safety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001931.htm Thyroid disorders Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001159.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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DELIRIUM DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-Hydroxytryptophan: Precursor of serotonin used as antiepileptic and antidepressant. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjustment Disorders: Maladaptive reactions to identifiable psychosocial stressors occurring within a short time after onset of the stressor. They are manifested by either

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impairment in social or occupational functioning or by symptoms (depression, anxiety, etc.) that are in excess of a normal and expected reaction to the stressor. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agents: Drugs that act on adrenergic receptors or affect the life cycle of adrenergic transmitters. Included here are adrenergic agonists and antagonists and agents that affect the synthesis, storage, uptake, metabolism, or release of adrenergic transmitters. [NIH]

Adverse Effect: An unwanted side effect of treatment. [NIH] Affective Symptoms: Mood or emotional responses dissonant with or inappropriate to the behavior and/or stimulus. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alcohol Withdrawal Delirium: Temporary state of mental confusion because of active uncontrolled imagination and faulty judgment. Among the causes are intoxications. [NIH]

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Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amantadine: An antiviral that is used in the prophylactic or symptomatic treatment of Influenza A. It is also used as an antiparkinsonian agent, to treat extrapyramidal reactions, and for postherpetic neuralgia. The mechanisms of its effects in movement disorders are not well understood but probably reflect an increase in synthesis and release of dopamine, with perhaps some inhibition of dopamine uptake. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are

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included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antecedent: Existing or occurring before in time or order often with consequential effects. [EU]

Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms.

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[NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are

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caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipsychotic Agents: Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in schizophrenia, senile dementia, transient psychosis following surgery or myocardial infarction, etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. [NIH] Antitussive: An agent that relieves or prevents cough. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asterixis: A motor disturbance marked by intermittency of sustained contraction of groups of muscles. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH]

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Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autopsy: Postmortem examination of the body. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Baclofen: A GABA derivative that is a specific agonist at GABA-B receptors. It is used in the treatment of spasticity, especially that due to spinal cord damage. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Basilar Artery: The artery formed by the union of the right and left vertebral arteries; it runs from the lower to the upper border of the pons, where it bifurcates into the two posterior cerebral arteries. [NIH] Behavioral Symptoms: Observable manifestions of impaired psychological functioning. [NIH]

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is

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used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenic Amines: A group of naturally occurring amines derived by enzymatic decarboxylation of the natural amino acids. Many have powerful physiological effects (e.g., histamine, serotonin, epinephrine, tyramine). Those derived from aromatic amino acids, and also their synthetic analogs (e.g., amphetamine), are of use in pharmacology. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bioterrorism: The use of biological agents in terrorism. This includes the malevolent use of bacteria, viruses, or toxins against people, animals, or plants. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bladder: The organ that stores urine. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found

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in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carbon Monoxide Poisoning: Toxic asphyxiation due to the displacement of oxygen from oxyhemoglobin by carbon monoxide. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH]

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Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH]

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Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chickenpox: A mild, highly contagious virus characterized by itchy blisters all over the body. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorpromazine: The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class chlorpromazine's antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [NIH] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Choroid Plexus: A villous structure of tangled masses of blood vessels contained within the third, lateral, and fourth ventricles of the brain. It regulates part of the production and composition of cerebrospinal fluid. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and

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emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial

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diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH]

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Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH]

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Cytomegalovirus Infections: Infection with Cytomegalovirus, characterized by enlarged cells bearing intranuclear inclusions. Infection may be in almost any organ, but the salivary glands are the most common site in children, as are the lungs in adults. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delusion: A false belief, not susceptible to argument or reason, and determined, pathologically, by some form of mental disorder. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU]

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Disposition: A tendency either physical or mental toward certain diseases. [EU] Diuresis: Increased excretion of urine. [EU] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Donepezil: A drug used in the treatment of Alzheimer's disease. It belongs to the family of drugs called cholinesterase inhibitors. It is being studied as a treatment for side effects caused by radiation therapy to the brain. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspnea: Difficult or labored breathing. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electroconvulsive Therapy: Electrically induced convulsions primarily used in the treatment of severe affective disorders and schizophrenia. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been

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transported from a distant site by the blood stream. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a

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fungus. [NIH] Ergotamine: A vasoconstrictor found in ergot of Central Europe. It is an alpha-1 selective adrenergic agonist and is commonly used in the treatment of migraine headaches. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Flatus: Gas passed through the rectum. [NIH] Flunitrazepam: Benzodiazepine with pharmacologic actions similar to those of diazepam. The United States Government has banned the importation of this drug. Steps are being taken to reclassify this substance as a Schedule 1 drug with no accepted medical use. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH]

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Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH]

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Haloperidol: Butyrophenone derivative. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic

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decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. [NIH] Hydration: Combining with water. [NIH] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH]

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Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Imagination: A new pattern of perceptual or ideational material derived from past experience. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local

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infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH]

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Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Jealousy: An irrational reaction compounded of grief, loss of self-esteem, enmity against the rival and self criticism. [NIH] Job Satisfaction: Personal satisfaction relative to the work situation. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lung Transplantation: The transference of either one or both of the lungs from one human or animal to another. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of

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the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions

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which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mianserin: A tetracyclic compound with antidepressant effects. It may cause drowsiness and hematological problems. Its mechanism of therapeutic action is not well understood, although it apparently blocks alpha-adrenergic, histamine H1, and some types of serotonin receptors. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological

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Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Mononuclear: A cell with one nucleus. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephropathy: Disease of the kidneys. [EU]

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Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury. [NIH] Neuropsychology: A branch of psychology which investigates the correlation between experience or behavior and the basic neurophysiological processes. The term neuropsychology stresses the dominant role of the nervous system. It is a more narrowly defined field than physiological psychology or psychophysiology. [NIH] Neurotensin: A biologically active tridecapeptide isolated from the hypothalamus. It has been shown to induce hypotension in the rat, to stimulate contraction of guinea pig ileum and rat uterus, and to cause relaxation of rat duodenum. There is also evidence that it acts as both a peripheral and a central nervous system neurotransmitter. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal

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transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing aide: Nursing assistant with minimum training in basic nursing care. [NIH] Nursing Assessment: Evaluation of the nature and extent of nursing problems presented by a patient for the purpose of patient care planning. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oncology: The study of cancer. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an

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analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Orderly: A male hospital attendant. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid) disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Paranoid Disorders: Chronic mental disorders in which there has been an insidious development of a permanent and unshakeable delusional system (persecutory delusions or delusions of jealousy), accompanied by preservation of clear and orderly thinking. Emotional responses and behavior are consistent with the delusional state. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural

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and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Planning: Usually a written medical and nursing care program designed for a particular patient. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is

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used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pneumonia: Inflammation of the lungs. [NIH] Podophyllin: Caustic extract from the roots of Podophyllum peltatum and P. emodi. It contains podophyllotoxin and its congeners and is very irritating to mucous membranes and skin. Podophyllin is a violent purgative that may cause CNS damage and teratogenesis. It is used as a paint for warts, skin neoplasms, and senile keratoses. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU]

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Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Posterior Cerebral Artery: Artery formed by the bifurcation of the basilar artery. Branches of the posterior cerebral artery supply portions of the occipital lobe, parietal lobe, inferior temporal gyrus, brainstem, and choroid plexus. [NIH] Postherpetic Neuralgia: Variety of neuralgia associated with migraine in which pain is felt in or behind the eye. [NIH] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH]

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Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychometrics: Assessment of psychological variables by the application of mathematical procedures. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH]

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Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH]

Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychosomatic Medicine: A system of medicine which aims at discovering the exact nature of the relationship between the emotions and bodily function, affirming the principle that the mind and body are one. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons,

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and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative

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risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Replicon: In order to be replicated, DNA molecules must contain an origin of duplication and in bacteria and viruses there is usually only one per genome. Such molecules are called replicons. [NIH] Research Support: Financial support of research activities. [NIH] Residual Volume: The volume of air remaining in the lungs at the end of a maximal expiration. Common abbreviation is RV. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Ritalin: Drug used to treat hyperactive children. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH]

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Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senility: Old age; the physical and mental deterioration associated with old age. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH]

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Skin Neoplasms: Tumors or cancer of the skin. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Statistically significant: Describes a mathematical measure of difference between groups.

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The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stramonium: One of the very toxic Solanaceae, Datura stramonium, also called thornapple and jimsonweed. It contains the same alkaloids as in Belladonna and causes toxicity to cattle and other grazers. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Supraspinal: Above the spinal column or any spine. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH]

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Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Teratogenesis: Production of monstrous growths or fetuses. [NIH] Terminal Care: Medical and nursing care of patients in the terminal stage of an illness. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a

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specific function. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH]

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Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Valproic Acid: A fatty acid with anticonvulsant properties used in the treatment of epilepsy.

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The mechanisms of its therapeutic actions are not well understood. It may act by increasing GABA levels in the brain or by altering the properties of voltage dependent sodium channels. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viremia: The presence of viruses in the blood. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Void: To urinate, empty the bladder. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Word Processing: Automated production of typewritten documents with text editing and

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storage functions using computer software. [NIH] Yellow Fever: An acute infectious disease primarily of the tropics, caused by a virus and transmitted to man by mosquitoes of the genera Aedes and Haemagogus. [NIH] Yellow Fever Virus: The type species of the Flavivirus genus. Principal vector transmission to humans is by Aedes spp. mosquitoes. [NIH] Ziconotide: A drug used in the treatment of chronic pain. Also called SNX 111. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

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INDEX 5 5-Hydroxytryptophan, 46, 131 A Abdominal, 14, 131, 154, 161 Acetylcholine, 45, 131, 141, 159 Acetylcholinesterase, 60, 131 Acidosis, 32, 131 Acquired Immunodeficiency Syndrome, 117, 131 Actin, 131, 158, 174 Activities of Daily Living, 14, 22, 86, 131 Adaptation, 131, 141 Adenosine, 131, 139, 162 Adenylate Cyclase, 80, 131 Adjustment, 91, 131 Adjustment Disorders, 91, 131 Adrenal Cortex, 132, 144 Adrenal Medulla, 132, 140, 147, 159 Adrenergic, 80, 132, 133, 134, 135, 146, 147, 148, 157, 164, 171, 174 Adrenergic Agents, 80, 132 Adverse Effect, 9, 16, 132, 142, 169 Affective Symptoms, 89, 132 Affinity, 132, 136, 142, 170 Age of Onset, 5, 132, 139 Agonist, 132, 137, 146, 148 Airway, 132, 170 Akathisia, 132, 135 Albumin, 132, 157, 163 Alcohol Withdrawal Delirium, 31, 44, 61, 132 Alertness, 133, 139 Algorithms, 133, 138 Alkaline, 131, 133, 139 Alkaloid, 133, 142, 158 Allylamine, 133 Alpha-1, 133, 148 Alprenolol, 133, 157 Alternative medicine, 100, 133 Alveoli, 133, 175 Amantadine, 63, 133 Amenorrhea, 133, 134 Amine, 10, 133, 150 Amino acid, 12, 46, 58, 133, 138, 149, 162, 164, 165, 169, 172, 173, 174 Ammonia, 128, 133 Amnestic, 84, 88, 92, 133, 157 Amphetamine, 133, 138

Amygdala, 10, 134, 137, 154 Anal, 13, 134, 155 Analgesic, 14, 134, 147, 158, 161 Analog, 134, 149 Anatomical, 10, 134, 137, 141, 152, 157, 169 Anemia, 16, 44, 126, 134, 150 Anesthesia, 8, 14, 35, 37, 38, 40, 49, 57, 60, 71, 72, 132, 134, 157 Anesthesiology, 14, 20, 35, 39, 40, 134 Anesthetics, 134, 147 Angina, 80, 134, 157, 164 Angina Pectoris, 80, 134, 157, 164 Anions, 132, 134, 154, 169 Annealing, 134, 163 Anorexia, 42, 80, 134 Anorexia Nervosa, 42, 134 Antagonism, 134, 139, 142 Antecedent, 96, 134 Anti-Anxiety Agents, 134, 166, 173 Antibacterial, 134, 170 Antibiotic, 16, 134, 135, 170 Antibiotic Prophylaxis, 16, 135 Antibody, 132, 135, 143, 151, 152, 156, 167, 170 Anticholinergic, 6, 30, 47, 58, 61, 66, 72, 135, 163 Anticoagulant, 135, 165 Anticonvulsant, 135, 155, 174 Antidepressive Agents, 135, 166 Antiemetic, 135, 141, 145 Antiepileptic, 131, 135 Antigen, 132, 135, 143, 151, 152, 156, 157 Anti-inflammatory, 135, 149 Antimetabolite, 135, 168 Antipsychotic, 98, 135, 136, 141, 142, 159, 168, 173 Antipsychotic Agents, 98, 136, 173 Antitussive, 136, 145, 161 Antiviral, 18, 24, 133, 136, 168 Anus, 134, 136, 142, 153 Anxiety, 18, 80, 85, 87, 89, 97, 126, 132, 134, 136, 155, 164 Anxiety Disorders, 89, 136 Anxiolytic, 136, 157, 160 Aphasia, 133, 136 Apnea, 136 Arrhythmia, 8, 42, 136 Arterial, 133, 136, 151, 165, 172

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Arteries, 83, 136, 137, 139, 144, 157, 158 Arterioles, 136, 139, 158 Artery, 8, 12, 43, 53, 77, 136, 137, 139, 144, 147, 164, 166, 175 Aspiration, 23, 136 Assay, 18, 66, 136 Asterixis, 6, 136 Astrocytes, 136, 157 Ataxia, 136, 140, 151 Atrial, 8, 39, 137 Atrial Fibrillation, 8, 39, 137 Atrium, 137, 175 Attenuated, 45, 137, 174 Atypical, 137, 142, 168 Autoimmune disease, 137, 158 Autonomic, 10, 39, 131, 135, 137, 159, 162 Autopsy, 10, 137 Autosuggestion, 137, 152 B Back Pain, 86, 137 Baclofen, 137 Bacteria, 134, 135, 137, 138, 147, 149, 157, 165, 168, 170, 173, 174 Bacteriophage, 137, 173 Bacteriuria, 137, 174 Basal Ganglia, 135, 136, 137, 139, 141, 154 Basal Ganglia Diseases, 136, 137, 141 Basilar Artery, 137, 164 Behavioral Symptoms, 84, 86, 89, 137 Benign, 80, 137, 139, 150, 158, 175 Benzene, 137, 138 Benzodiazepines, 6, 61, 98, 138 Bereavement, 87, 97, 138 Bewilderment, 138, 143 Bile, 138, 148, 152, 154, 171 Bile duct, 138, 152 Bilirubin, 41, 132, 138 Biochemical, 12, 30, 135, 138, 162, 169 Biogenic Amines, 30, 138 Biotechnology, 25, 26, 100, 111, 138 Bioterrorism, 23, 138 Biotransformation, 138 Bipolar Disorder, 36, 97, 138 Bismuth, 30, 138 Bladder, 12, 138, 141, 152, 158, 174, 175 Blood Cell Count, 138, 150 Blood Coagulation, 138, 139, 172 Blood Glucose, 138, 150, 152, 153 Blood Platelets, 138, 169 Blood pressure, 139, 140, 141, 151, 152, 157, 170 Blood transfusion, 15, 139

Blood vessel, 139, 140, 141, 146, 162, 170, 171, 172, 175 Blood-Brain Barrier, 139, 162 Body Fluids, 139, 170 Bowel, 134, 139, 171 Brain Neoplasms, 139, 151 Bronchitis, 139, 141 Buccal, 139, 155 Bulimia, 80, 139 Bypass, 8, 12, 43, 77, 139 C Caffeine, 55, 139 Calcium, 127, 139, 143, 174 Carbon Monoxide Poisoning, 6, 139 Carcinogenic, 138, 139, 153, 171 Cardiac, 8, 12, 14, 36, 41, 42, 44, 56, 69, 133, 137, 139, 147, 148, 157, 158, 171 Cardiorespiratory, 140, 157 Cardioselective, 140, 164 Cardiovascular, 10, 11, 14, 16, 17, 27, 49, 53, 56, 71, 101, 134, 140, 169 Cardiovascular disease, 16, 101, 140 Case report, 27, 28, 36, 40, 47, 57, 60, 61, 62, 64, 66, 70, 140 Case series, 140 Cataract, 32, 70, 128, 140, 147 Catecholamine, 135, 140, 146 Caudal, 140, 152, 164 Central Nervous System Infections, 140, 150, 151 Centrifugation, 140, 150 Cerebellar, 136, 140, 173 Cerebellar Diseases, 136, 140, 173 Cerebral, 49, 57, 92, 136, 137, 139, 140, 141, 144, 147, 151, 160, 161, 164, 165, 166, 172 Cerebral Cortex, 92, 136, 140, 166 Cerebrospinal, 127, 140, 141, 151, 155, 170 Cerebrospinal fluid, 127, 140, 141, 151, 155, 170 Cerebrovascular, 84, 137, 140, 141 Cerebrum, 140, 141, 172 Character, 134, 141, 145 Chemoreceptor, 135, 141 Chickenpox, 116, 141 Chin, 141, 156 Chlorpromazine, 7, 141 Choline, 131, 141 Cholinergic, 6, 92, 135, 141 Cholinesterase Inhibitors, 141, 146 Chorea, 135, 141 Choroid, 141, 164 Choroid Plexus, 141, 164

179

Chronic Disease, 15, 101, 141 Chronic Obstructive Pulmonary Disease, 9, 141 Chronic renal, 15, 31, 142 Cisplatin, 142, 160 Clinical trial, 8, 13, 111, 142, 165, 167 Cloning, 138, 142 Clozapine, 46, 104, 142 Coca, 142 Cocaine, 9, 32, 39, 142 Cofactor, 142, 165, 172 Cognition, 10, 21, 81, 142, 159 Collagen, 133, 142 Collapse, 142, 170 Colloidal, 132, 142, 146, 169 Colon, 142, 152, 154 Comorbidity, 5, 142 Complement, 143, 163 Complementary and alternative medicine, 69, 75, 143 Complementary medicine, 69, 143 Computational Biology, 111, 143 Concomitant, 4, 143 Confidence Intervals, 16, 143 Confusion, 5, 9, 11, 14, 21, 32, 36, 37, 38, 49, 62, 83, 85, 93, 101, 126, 132, 143, 145, 152, 159, 174 Congestion, 135, 143 Congestive heart failure, 4, 8, 143 Conjunctiva, 144, 162 Consciousness, 4, 10, 81, 92, 125, 134, 144, 145, 165 Constipation, 48, 135, 144, 148, 154 Consultation, 7, 12, 85, 144 Contraindications, ii, 144 Convulsions, 135, 144, 146, 152 Coordination, 85, 95, 144, 158 Coronary, 8, 12, 43, 53, 77, 134, 140, 144, 157, 158 Coronary Arteriosclerosis, 144, 158 Coronary Circulation, 134, 144 Coronary heart disease, 140, 144 Coronary Thrombosis, 144, 157, 158 Cortex, 10, 144 Cortical, 92, 144, 148, 169 Cortisol, 30, 81, 132, 144 Craniocerebral Trauma, 137, 144, 150, 151 Critical Care, 24, 29, 31, 33, 34, 37, 43, 45, 48, 49, 52, 53, 56, 71, 144 Curative, 144, 159, 172 Cutaneous, 144, 155 Cyclic, 131, 139, 144, 162

Cytomegalovirus, 144, 145, 149 Cytomegalovirus Infections, 145, 149 Cytotoxic, 145, 160 Cytotoxic chemotherapy, 145, 160 D Deamination, 145, 157 Decarboxylation, 138, 145, 151 Degenerative, 92, 93, 145, 150 Delusion, 27, 145 Dementia, 3, 4, 5, 6, 7, 11, 15, 18, 21, 28, 29, 32, 33, 35, 37, 41, 43, 45, 46, 48, 49, 50, 56, 59, 61, 63, 71, 80, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 95, 96, 97, 98, 100, 101, 116, 131, 135, 136, 145 Denaturation, 145, 163 Dendrites, 145, 159 Depressive Disorder, 145, 154 Deprivation, 71, 145 Diabetes Mellitus, 145, 150 Diagnostic Errors, 145, 156 Diagnostic procedure, 79, 100, 145 Diarrhea, 145, 148, 154 Diastole, 145 Diastolic, 8, 145, 151 Digestion, 138, 139, 145, 154, 162, 171 Dilation, 145, 151 Diphenhydramine, 27, 47, 100, 145 Direct, iii, 23, 84, 90, 103, 145, 146, 151, 164, 167, 172 Disorientation, 81, 143, 145 Disposition, 46, 146 Diuresis, 139, 146 Diurnal, 6, 146 Dizziness, 86, 146 Donepezil, 6, 35, 146 Dopamine, 9, 45, 127, 133, 135, 141, 142, 146, 157, 159, 162, 168 Dorsal, 146, 164 Drug Interactions, 104, 105, 146 Duodenum, 138, 146, 147, 159, 162, 171 Dura mater, 146, 156, 161 Dyskinesia, 135, 146 Dyspnea, 48, 146 E Echocardiography, 8, 146 Effector, 80, 131, 143, 146, 162 Efficacy, 15, 37, 146 Elective, 14, 146 Electroconvulsive Therapy, 4, 44, 55, 146 Electrolyte, 128, 146, 170 Electrophoresis, 20, 146 Emaciation, 131, 146

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Embolism, 146 Embolus, 147, 152 Emesis, 136, 147 Emphysema, 142, 147 Empirical, 28, 147 Encephalitis, 18, 24, 147 Encephalitis, Viral, 147 Encephalopathy, 41, 147 Endogenous, 146, 147 Endorphin, 30, 147 Endoscopic, 147, 157 End-stage renal, 142, 147 Enkephalins, 147, 159 Environmental Health, 110, 112, 147 Enzymatic, 133, 138, 139, 143, 147, 150, 163 Enzyme, 80, 131, 146, 147, 157, 162, 163, 165, 172, 175, 176 Epidemic, 97, 147 Epinephrine, 132, 138, 146, 147, 159, 174 Ergot, 147, 148 Ergotamine, 55, 148 Erythrocytes, 134, 138, 148 Esophagus, 148, 162, 171 Excitability, 148, 159 Excitation, 38, 141, 148, 159 Excitatory, 137, 148, 149 Exogenous, 138, 147, 148 Expiration, 148, 168 Extraction, 70, 148 Extrapyramidal, 5, 38, 132, 133, 135, 146, 148 Extravasation, 148, 150 F Family Planning, 111, 148 Fat, 144, 147, 148, 154, 158 Fatigue, 148, 150 Febrile, 46, 148 Femoral, 16, 148 Femur, 148 Fibrinogen, 148, 163, 172 Flatus, 148, 149 Flunitrazepam, 27, 44, 148 Functional Disorders, 85, 148 G Gait, 4, 11, 140, 148 Gallbladder, 131, 148 Ganciclovir, 18, 149 Ganglia, 131, 137, 149, 159, 162 Gas, 127, 133, 148, 149, 151, 154, 159, 168, 175 Gas exchange, 149, 168, 175 Gastric, 149, 151, 162

Gastric Juices, 149, 162 Gastrin, 149, 151 Gastrointestinal, 26, 141, 147, 149, 169 Gastrointestinal tract, 141, 149, 169 Gene, 10, 20, 138, 149 Gene Expression, 20, 149 Genetic testing, 149, 163 Genetics, 92, 149 Glomerular, 149, 168 Glucocorticoid, 81, 149 Glucose, 127, 138, 145, 149, 150, 152, 153 Glutamate, 149, 157 Glutamic Acid, 149, 159 Glycine, 133, 149, 159 Glycoprotein, 148, 149, 172 Governing Board, 149, 164 Graft, 8, 12, 43, 77, 149 H Haloperidol, 7, 38, 41, 53, 61, 66, 104, 150 Headache, 139, 150, 151, 152 Health Services, 9, 150 Heart attack, 140, 150 Heart failure, 8, 9, 80, 150 Heartbeat, 150, 171 Hematocrit, 15, 138, 150 Hematoma, 4, 150 Heme, 138, 150 Hemoglobin, 15, 134, 138, 148, 150 Hemorrhage, 144, 150, 171 Hemostasis, 150, 169 Hepatic, 41, 132, 150, 157 Hepatitis, 15, 24, 150 Hepatocytes, 150 Heredity, 149, 150 Heterogeneity, 4, 132, 150 Hiccup, 141, 150 Histamine, 41, 135, 138, 145, 150, 157 Homologous, 151, 172 Hormone, 80, 128, 144, 147, 149, 151, 153 Hospital Charges, 151 Hospital Costs, 13, 151 Hospital Mortality, 13, 151 Hydration, 28, 151 Hydrocephalus, 4, 151, 153 Hydrogen, 131, 133, 145, 151, 157 Hydrogenation, 138, 151 Hydrolysis, 80, 131, 138, 142, 151, 164, 165 Hydroxyproline, 133, 142, 151 Hypersensitivity, 145, 151 Hypertension, 80, 101, 140, 151, 153, 157, 164 Hyperthyroidism, 73, 151, 164

181

Hypertrophy, 80, 151 Hypnotic, 145, 152, 155, 157 Hypoglycaemia, 152 Hypoglycemic, 39, 152 Hypotension, 80, 135, 144, 152, 159 Hypothalamic, 41, 152 Hypothalamus, 139, 152, 154, 159 Hypoxia, 6, 126, 152 I Iatrogenic, 42, 69, 152 Ileum, 152, 159 Ileus, 152 Imagination, 132, 152 Immune response, 135, 137, 152, 175 Immunodeficiency, 91, 95, 96, 97, 98, 116, 117, 131, 152 Immunodeficiency syndrome, 91, 95, 97, 98, 152 Immunosuppressive, 149, 152 Impaction, 6, 152 Incontinence, 5, 86, 97, 151, 152 Induction, 135, 152 Infarction, 28, 151, 152 Infection, 16, 90, 98, 131, 144, 145, 147, 152, 155, 161, 171 Infusion, 47, 153, 173 Ingestion, 71, 72, 153, 163 Initiation, 6, 153 Inositol, 153, 157 Inotropic, 146, 153 Inpatients, 3, 26, 28, 34, 41, 49, 54, 57, 59, 61, 153 Insulator, 153, 158 Insulin, 153 Insulin-dependent diabetes mellitus, 153 Intensive Care, 23, 26, 27, 29, 33, 37, 44, 48, 49, 53, 55, 66, 70, 153 Intermittent, 153, 155 Interstitial, 153, 168 Intestines, 131, 149, 152, 153 Intoxication, 27, 46, 153, 175 Intracellular, 139, 152, 153, 157, 167 Intracranial Hemorrhages, 151, 153 Intracranial Hypertension, 150, 151, 153 Intravenous, 38, 40, 41, 44, 153 Invasive, 153, 155 Involuntary, 45, 137, 141, 153, 158 Ions, 146, 151, 154, 170 Irritable Bowel Syndrome, 148, 154 J Jealousy, 154, 161 Job Satisfaction, 22, 154

K Kb, 110, 154 Kidney Disease, 15, 110, 154 Kinetic, 154 L Length of Stay, 41, 154 Lens, 140, 154 Lesion, 89, 154, 172 Lethargy, 126, 151, 154 Life cycle, 132, 154 Ligaments, 144, 154 Limbic, 134, 154 Limbic System, 134, 154 Linkages, 150, 154 Lipid, 141, 153, 154, 157, 158 Lithium, 27, 47, 135, 154 Liver, 51, 127, 131, 132, 138, 144, 148, 150, 154, 157 Liver Transplantation, 51, 154 Localized, 150, 152, 155, 157, 163 Longitudinal Studies, 19, 155 Longitudinal study, 15, 155 Long-Term Care, 12, 13, 15, 89, 155 Loop, 19, 155 Lorazepam, 39, 155 Lumbar, 5, 137, 155, 170 Lumbar puncture, 5, 155, 170 Lung Transplantation, 41, 155 Lupus, 57, 155 Lymphatic, 153, 155 Lymphocyte, 131, 135, 155, 156 Lymphocyte Count, 131, 155 M Magnetic Resonance Imaging, 30, 155 Malignant, 131, 139, 155, 158 Mania, 41, 63, 97, 155 Manic, 80, 135, 138, 154, 155, 166 Manifest, 21, 97, 155 Mechanical ventilation, 10, 24, 155 Mediate, 146, 155 Mediator, 155, 169 Medical Errors, 9, 16, 156 Medical Records, 21, 156, 168 Medication Errors, 156 MEDLINE, 111, 156 Meiosis, 156, 172 Melanin, 156, 162, 174 Membrane, 136, 141, 143, 144, 148, 156, 158, 161, 162, 170, 173 Memory, 11, 81, 84, 87, 88, 95, 134, 145, 156 Meninges, 140, 144, 146, 156

182

Delirium

Meningitis, 101, 156 Menopause, 156, 164 Mental Disorders, 18, 84, 85, 88, 89, 92, 156, 161, 165, 166 Mental Health, iv, 8, 19, 69, 84, 85, 87, 89, 96, 110, 112, 156, 166 Mental Processes, 156, 165 Mental Retardation, 80, 156 Mentors, 11, 15, 156 Mesolimbic, 135, 156 Meta-Analysis, 5, 156 Metabotropic, 157 Metoprolol, 27, 157 MI, 129, 157 Mianserin, 7, 37, 157 Microbe, 157, 173 Microglia, 136, 157 Midazolam, 47, 157 Modification, 133, 157, 166 Molecular, 10, 20, 111, 113, 138, 143, 148, 157, 167 Molecule, 135, 143, 146, 148, 151, 157, 167, 175 Monitor, 10, 29, 157 Monoamine, 92, 133, 135, 157, 174 Monoamine Oxidase, 92, 133, 135, 157, 174 Mononuclear, 20, 158 Mood Disorders, 85, 97, 158 Morphine, 44, 55, 158, 160 Morphology, 140, 158 Motility, 148, 158, 169 Mucociliary, 158, 169 Mucosa, 155, 158 Multiple sclerosis, 27, 158 Myelin, 158 Myocardial infarction, 16, 80, 136, 144, 157, 158, 164 Myocardial Ischemia, 14, 134, 158 Myocardium, 134, 157, 158 Myosin, 158, 174 N Narcotic, 158 Nausea, 135, 136, 158, 160, 174 Necrosis, 152, 157, 158 Neoplasms, 131, 139, 158 Nephropathy, 154, 158 Nerve, 116, 132, 134, 136, 141, 145, 148, 156, 157, 158, 159, 161, 169, 171, 173 Nervous System, 18, 23, 89, 95, 101, 128, 131, 133, 138, 139, 140, 141, 142, 149, 156, 157, 158, 159, 162, 163, 169, 171, 174

Nervousness, 86, 159 Neural, 45, 50, 157, 159, 170 Neuroleptic, 132, 135, 142, 159, 160 Neurologic, 10, 86, 92, 116, 134, 151, 159 Neuromuscular, 131, 159 Neuromuscular Junction, 131, 159 Neurons, 10, 142, 145, 148, 149, 159, 172 Neuropsychological Tests, 9, 159 Neuropsychology, 15, 159 Neurotensin, 80, 159 Neurotic, 134, 159, 174 Neurotransmitter, 20, 131, 133, 141, 146, 149, 151, 159, 174 Niacin, 159, 174 Nitrogen, 133, 159, 174 Nonverbal Communication, 159, 166 Norepinephrine, 9, 132, 146, 159 Nuclei, 134, 154, 155, 160 Nucleic acid, 159, 160, 168 Nucleus, 136, 137, 144, 156, 158, 160, 164, 171 Nursing aide, 87, 160 Nursing Assessment, 96, 160 Nursing Care, 7, 86, 160, 162, 172 Nursing Staff, 19, 160 Nutritional Status, 89, 160 O Observational study, 31, 160 Occipital Lobe, 160, 164 Odds Ratio, 160, 168 Oncology, 57, 160 Ondansetron, 53, 60, 160 Opacity, 140, 160 Ophthalmologic, 66, 160 Ophthalmology, 160 Opiate, 158, 160 Opium, 158, 160 Opportunistic Infections, 131, 161 Orderly, 161 Orthopaedic, 48, 161 Orthostatic, 135, 161 Osmotic, 132, 161, 169 Osteoporosis, 80, 161 Outpatient, 98, 161 P Pachymeningitis, 156, 161 Palliative, 20, 28, 32, 43, 48, 58, 161, 172 Pancreas, 131, 153, 161 Paranoia, 87, 96, 161 Paranoid Disorders, 85, 161 Parietal, 161, 164 Parietal Lobe, 161, 164

183

Parkinsonism, 135, 161 Paroxetine, 34, 55, 161 Paroxysmal, 134, 161 Particle, 161, 173 Pathogenesis, 89, 93, 99, 161 Pathologic, 131, 144, 151, 161, 164, 168 Pathologies, 61, 162 Pathophysiology, 3, 6, 20, 58, 92, 162 Patient Care Planning, 160, 162 Patient Education, 116, 120, 122, 129, 162 Pelvis, 155, 162, 174 Pepsin, 162 Peptic, 101, 162 Peptic Ulcer, 101, 162 Peptide, 133, 162, 164, 165 Perfusion, 49, 152, 162 Perioperative, 8, 162 Peripheral blood, 20, 162 Peripheral Nervous System, 147, 159, 162 Pharmacists, 22, 47, 162 Pharmacodynamics, 22, 24, 162 Pharmacokinetic, 162 Pharmacologic, 5, 21, 29, 90, 134, 148, 162, 173, 174 Phenylalanine, 12, 162, 174 Phosphodiesterase, 80, 162 Phosphorus, 139, 162 Physiologic, 132, 162, 167, 168, 173 Physostigmine, 46, 71, 72, 162 Pigment, 138, 163 Pilot study, 9, 16, 18, 163 Plants, 133, 138, 141, 142, 149, 158, 160, 163, 173 Plasma, 18, 24, 44, 132, 148, 150, 157, 163, 169 Plasma protein, 132, 163, 169 Platinum, 142, 155, 163 Pneumonia, 16, 101, 144, 163 Podophyllin, 70, 163 Podophyllotoxin, 163 Poisoning, 73, 147, 153, 158, 163 Polymerase, 18, 163 Polymerase Chain Reaction, 18, 163 Polymorphic, 5, 163 Polypeptide, 133, 142, 148, 164, 176 Posterior, 28, 134, 136, 137, 141, 146, 160, 161, 164 Posterior Cerebral Artery, 28, 164 Postherpetic Neuralgia, 133, 164 Postmenopausal, 161, 164 Postoperative, 8, 14, 16, 20, 26, 28, 30, 36, 38, 49, 55, 62, 63, 72, 164

Postoperative Complications, 16, 164 Practice Guidelines, 112, 164 Precursor, 131, 141, 146, 147, 159, 162, 164, 174 Preoperative, 8, 44, 164 Presynaptic, 159, 164 Prevalence, 4, 5, 10, 12, 15, 21, 23, 24, 25, 26, 43, 77, 84, 160, 164 Probe, 18, 164 Progression, 10, 15, 90, 164 Progressive, 17, 92, 142, 145, 158, 164, 168 Projection, 160, 164 Prophase, 164, 172 Prophylaxis, 16, 164 Propofol, 57, 61, 164 Propranolol, 47, 164 Prospective study, 15, 18, 23, 52, 59, 70, 101, 155, 165 Protein C, 80, 132, 137, 165, 174 Protein S, 80, 138, 165 Proteins, 20, 80, 133, 135, 142, 143, 157, 159, 162, 163, 165, 167, 169, 173, 174 Proteolytic, 133, 143, 148, 165 Protocol, 22, 24, 165 Protozoa, 165, 174 Protozoal, 165 Protozoan, 80, 140, 165 Pruritus, 136, 145, 165 Psychic, 156, 165, 166, 169 Psychoactive, 19, 72, 165, 175 Psychogenic, 165, 174 Psychology, 20, 85, 96, 159, 165 Psychometrics, 11, 165 Psychomotor, 6, 97, 159, 165 Psychopathology, 84, 165 Psychopharmacology, 7, 27, 37, 41, 46, 52, 55, 72, 88, 98, 165 Psychophysiology, 159, 166 Psychosis, 11, 17, 30, 71, 89, 97, 135, 136, 166 Psychosomatic, 44, 71, 166 Psychosomatic Medicine, 71, 166 Psychotherapy, 88, 97, 98, 166 Psychotropic, 19, 87, 89, 166 Psychotropic Drugs, 87, 89, 166 Public Health, 16, 96, 98, 112, 166 Public Policy, 23, 111, 166 Publishing, 25, 87, 90, 166 Pulmonary, 24, 53, 139, 166, 175 Pulse, 157, 166 Purgative, 163, 166 Pyramidal Tracts, 148, 166

184

Delirium

Q Quality of Life, 13, 20, 166, 171 R Radiation, 116, 134, 146, 166 Radiation therapy, 146, 166 Random Allocation, 167 Randomization, 16, 167 Randomized, 8, 14, 15, 21, 22, 24, 25, 26, 59, 146, 167 Randomized clinical trial, 15, 167 Reactivation, 18, 167 Reality Testing, 166, 167 Receptor, 10, 41, 60, 80, 81, 131, 135, 141, 142, 146, 157, 160, 167, 169 Receptors, Serotonin, 167, 169 Recombinant, 80, 167, 175 Rectum, 136, 142, 148, 149, 152, 167 Recurrence, 21, 138, 167 Refer, 1, 139, 143, 146, 159, 166, 167 Refraction, 167, 170 Refractory, 6, 47, 167 Regimen, 14, 146, 167 Relative risk, 16, 167 Reliability, 3, 9, 62, 88, 168 Remission, 138, 167, 168 Renal failure, 23, 168 Replicon, 24, 168 Research Support, 19, 168 Residual Volume, 12, 168 Resorption, 151, 168 Respiration, 136, 141, 157, 168 Respirator, 155, 168 Respiratory failure, 24, 168 Respiratory Physiology, 168, 175 Retrograde, 49, 168 Retrospective, 7, 10, 38, 72, 168 Retrospective study, 38, 72, 168 Ribavirin, 24, 168 Risk factor, 5, 8, 11, 12, 13, 14, 15, 18, 19, 21, 37, 43, 45, 56, 57, 96, 101, 165, 167, 168 Risperidone, 56, 57, 58, 60, 62, 75, 168 Ritalin, 98, 168 S Schizoid, 168, 175 Schizophrenia, 18, 80, 87, 136, 146, 161, 168, 169, 175 Schizotypal Personality Disorder, 169, 175 Sclerosis, 158, 169 Screening, 12, 24, 32, 38, 44, 46, 84, 86, 89, 142, 169, 174 Sedative, 24, 61, 99, 145, 155, 157, 169, 174

Sediment, 169, 174 Seizures, 18, 23, 60, 161, 169 Self Care, 131, 169 Senile, 83, 88, 136, 161, 163, 169 Senility, 12, 169 Sequencing, 163, 169 Serotonin, 9, 55, 58, 131, 135, 138, 142, 157, 159, 160, 161, 167, 168, 169, 174 Serum, 6, 12, 20, 27, 47, 58, 127, 128, 132, 143, 169 Serum Albumin, 47, 169 Shock, 23, 169, 173 Side effect, 103, 132, 135, 136, 146, 155, 169, 171, 173 Signs and Symptoms, 4, 17, 97, 168, 169 Sinusitis, 116, 169 Skeletal, 141, 169, 174 Skin Neoplasms, 163, 170 Sleep apnea, 52, 170 Small intestine, 146, 151, 152, 153, 170, 175 Smooth muscle, 133, 139, 151, 158, 170 Social Behavior, 98, 170 Social Environment, 166, 170 Social Work, 84, 87, 170 Sodium, 170, 175 Sodium Channels, 170, 175 Somatic, 154, 156, 161, 162, 170 Spatial disorientation, 146, 170 Specialist, 86, 118, 145, 170 Species, 147, 156, 170, 173, 174, 175, 176 Specificity, 12, 132, 170 Spectrum, 18, 98, 157, 170 Spinal cord, 136, 137, 140, 146, 156, 159, 161, 162, 166, 170 Spinal tap, 155, 170 Statistically significant, 37, 170 Steroid, 58, 144, 171 Stimulant, 133, 139, 151, 171 Stimulus, 132, 148, 171, 172 Stomach, 131, 148, 149, 151, 153, 158, 162, 170, 171 Stool, 142, 152, 154, 171 Stramonium, 66, 71, 72, 171 Strand, 163, 171 Stress, 95, 116, 140, 144, 148, 154, 158, 171 Stroke, 4, 15, 16, 33, 49, 88, 110, 116, 140, 171 Stupor, 10, 126, 154, 158, 171 Subacute, 153, 169, 171 Subclinical, 152, 169, 171 Subcutaneous, 47, 171 Sudden death, 10, 70, 171

185

Supportive care, 5, 171 Supraspinal, 137, 171 Sympathomimetic, 133, 146, 147, 160, 171, 174 Symptomatic, 16, 95, 133, 134, 171 Symptomatic treatment, 133, 134, 171 Synapse, 132, 159, 164, 172, 173 Synaptic, 159, 172 Systemic, 37, 104, 139, 147, 153, 167, 172 Systolic, 151, 172 T Tardive, 135, 172 Telencephalon, 137, 140, 172 Temporal, 134, 164, 172 Temporal Lobe, 134, 172 Teratogenesis, 163, 172 Terminal Care, 86, 172 Therapeutics, 105, 158, 172 Thermal, 163, 172 Thigh, 47, 148, 172 Thoracic, 49, 53, 56, 71, 137, 172 Thorax, 155, 172 Threshold, 15, 148, 151, 172 Thrombin, 148, 165, 172 Thrombomodulin, 165, 172 Thrombosis, 165, 171, 172 Thrombus, 144, 152, 158, 172 Thyroxine, 132, 162, 172 Topical, 66, 70, 104, 173 Torsion, 152, 173 Toxic, iv, 66, 72, 137, 139, 163, 171, 173 Toxicity, 10, 18, 39, 146, 163, 171, 173 Toxicokinetics, 173 Toxicology, 10, 112, 128, 173 Toxins, 135, 138, 147, 152, 173 Tranquilizing Agents, 166, 173 Transduction, 80, 153, 173 Transfection, 138, 173 Transfusion, 15, 173 Translation, 133, 173 Translational, 17, 173 Transmitter, 131, 136, 146, 156, 160, 173, 174 Transplantation, 142, 173 Trauma, 28, 92, 158, 173 Tremor, 6, 86, 161, 173 Trigger zone, 135, 173 Tropomyosin, 173, 174 Troponin, 14, 173, 174 Tryptophan, 13, 142, 169, 174 Tuberculosis, 155, 174

Tyramine, 138, 157, 174 Tyrosine, 146, 174 U Ulceration, 162, 174 Uremia, 168, 174 Ureters, 174 Urethra, 174 Urinalysis, 12, 128, 174 Urinary, 6, 12, 60, 80, 101, 137, 141, 151, 152, 174 Urinary Retention, 6, 80, 174 Urinary tract, 12, 101, 137, 174 Urinary tract infection, 12, 101, 137, 174 Urinate, 174, 175 Urine, 12, 137, 138, 146, 152, 174 Uterus, 159, 174 V Vaccines, 174, 175 Valerian, 69, 75, 174 Valproic Acid, 33, 174 Vascular, 56, 60, 86, 87, 133, 141, 152, 153, 172, 175 Vasodilator, 146, 151, 175 Vector, 173, 175, 176 Vein, 153, 175 Venous, 138, 165, 175 Ventilation, 11, 44, 175 Ventricle, 134, 152, 166, 172, 175 Ventricular, 151, 175 Veterinary Medicine, 111, 175 Villi, 151, 175 Viral, 16, 23, 80, 95, 147, 173, 175 Viremia, 18, 175 Virulence, 137, 173, 175 Virus, 18, 24, 90, 91, 95, 96, 97, 98, 116, 117, 131, 137, 140, 141, 173, 175, 176 Vitro, 163, 175 Void, 12, 175 W Wakefulness, 10, 175 War, 35, 175 Warts, 163, 175 Withdrawal, 17, 27, 29, 40, 42, 51, 54, 61, 69, 73, 175 Word Processing, 46, 175 Y Yellow Fever, 24, 176 Yellow Fever Virus, 24, 176 Z Ziconotide, 44, 176 Zymogen, 165, 176

186

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187

188

Delirium