UNASSIGNED: Coercion is rare in cancer treatment. We present a case where a young woman received gamma knife radiosurgery and immunochemotherapy under compulsory institutional care.
UNASSIGNED: A previously healthy patient in her thirties was admitted to hospital due to confusion, apathy, weight loss and sleep disturbance. She had difficulties expressing herself and spoke with considerable latency. A brain MRI revealed a tumour of 23 mm in the left-side centrum semiovale and perifocal oedema, while a CT scan showed a 5.6 cm tumour in the right upper lobe and enlarged mediastinal lymph nodes. She was diagnosed with non-small cell lung cancer, no actionable mutations, PD-L1 <75 %. When she did not wish to return to the hospital to undergo gamma knife radiosurgery, she was readmitted under a formal decision to use coercion, and remained under institutional care for over six months. Today she is fully recovered and has no cancer progression almost five years after diagnosis.
UNASSIGNED: This case report illustrates the challenges of brain metastases and use of coercion during cancer treatment, both for the patient and healthcare personnel. There is a need for thorough interdisciplinary discussions and to establish as early as possible a shared understanding of the intention and scope of the forced treatment.

We describe the case of a 73-year-old woman presenting with headaches, confusion, and vision disturbances. Brain MRI showed a large T2-hyperintense lesion in the right temporo-occipital region with vasogenic edema and leptomeningeal enhancement. A leptomeningeal biopsy was performed, which led to a definitive diagnosis.

Objective: While there is a growing body of evidence indicating a relationship between COPD and cognitive impairment, there is a gap in evidence regarding discussions of cognitive symptoms in healthcare settings. This study investigated the extent to which individuals with Chronic Obstructive Pulmonary Disease (COPD) and Subjective Cognitive Decline (SCD) self-reported confusion or memory loss with healthcare professionals. Methods: A secondary analysis of 2019 BRFSS data of US adults aged 45+ with COPD (N = 107,204), using logistic regression to explore associations between socio-demographic and health-related indicators with discussion of cognitive symptoms with healthcare professionals. Results: Less than half (45.88%) of individuals reporting SCD discussed their cognitive symptoms with their healthcare provider. In the adjusted model, unemployed (AOR = 2.92, 95% CI: 1.70-5.02, p < .005), retired (AOR = 3.16, 95% CI: 1.37-7.30, p < .01), and current smokers (AOR = 1.73, 95% CI: 1.02-2.93, p < .05) were more likely to discuss cognitive decline with a healthcare professional than their counterparts. In contrast, males (AOR = 0.53, 95% CI: 0.32-0.86, p < .05) and binge drinkers (AOR = 0.49, 95% CI: 0.30-0.79, p < .01) were significantly less likely to do so when compared to their counterparts. Discussion: The study highlighted significant disparities in the likelihood of individuals with COPD discussing cognitive symptoms based on socio-demographic and health risk behaviors. Conclusion: Addressing gender disparities, occupational status, and personal health risks is crucial for improving patient-provider communication about SCD among adults with COPD.

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Daptomycin (DAP) is a cyclic lipopeptide antibiotic with bactericidal activity against gram-positive bacteria. The most common adverse reaction is myotoxicity characterized by rhabdomyolysis. Other reported adverse reactions include gastrointestinal symptoms, skin lesions, bleeding, and pulmonary involvement. Neurotoxicity is rare and its mechanism remains partially elucidated. We report a case of confusion consistent with DAP-induced neurotoxicity. A 73-year-old obese man was treated with DAP 9 mg/kg for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with foot osteitis and cervical posterior inter-apophyseal arthritis. On the fifth day of treatment, he developed spatial disorientation, and serum DAP concentrations were very high. DAP-induced neurotoxicity was suggested. His neurological status returned to normal after treatment was stopped. This observation describes a relationship between confusion and DAP that is favored by obesity. Clinicians should be alert for neurologic disorders associated with DAP. It is prudent to reduce doses in obese patients.

INTRODUCTION: Spatial disorientation (SD) remains the leading contributor to Class A mishaps in the U.S. Navy, consistent with historical trends. Despite this, SD training for military aircrew is largely confined to the classroom and experiential training replicating SD illusions is limited and infrequent. Static flight simulators are most commonly used for training but offer no vestibular stimulation to the flight crew, omitting the source of vestibular-mediated SD.BACKGROUND: We first cover vestibular-mediated SD illusions which may be replicated through galvanic vestibular stimulation (GVS) in a static environment. GVS is a safe, reliable, low-cost avenue for providing vestibular sensory stimulation. We review the underlying mechanisms of GVS such as the excitement and inhibition of the afferent neurons innervating the vestibular system, particularly in the binaural bipolar electrode montage.APPLICATIONS: Two approaches for how GVS may be used to enhance SD training are examined. The first is a means for providing unreliable vestibular sensory perceptions to pilots, and the second details how GVS can be leveraged for replicating vestibular-mediated SD illusions.DISCUSSION: We recommend GVS be pursued as an enhancement to existing SD training. The ability to disorient aircrew in the safe training environment of a static flight simulator would allow for aircrew familiarization to SD, serving as an opportunity to practice life-saving checklist items to recover from SD. A repeatable training profile that could be worn by military aircrew in a static flight simulator may afford a low-cost training solution to the number one cause of fatalities in military aviation.Allred AR, Lippert AF, Wood SJ. Galvanic vestibular stimulation advancements for spatial disorientation training. Aerosp Med Hum Perform. 2024; 95(7):390-398.

The Behavioral Risk Factor Surveillance System (BRFSS) is a randomized national U.S. telephone survey administered by state health departments. This study aimed to identify how Black/African Americans understand BRFSS caregiver and cognitive decline surveys and terminology to inform health messaging that centers the Black/African American experience. In focus groups, BRFSS surveys were administered to Black/African Americans (n = 30) aged ≥ 45 in Oregon. Participants were asked how they interpreted BRFSS terms \'memory loss\' and \'confusion,\' how these terms related to Alzheimer\'s and dementia, and about caregiving and cognitive decline experiences. The culturally responsive Africana Worldview guided interpretation, which centers the Black/African American experience and individuals within interdependent relationships and community identity when explaining behaviors of people from the African diaspora. BRFSS survey responses differed from focus group responses to the same questions. Two participants reported providing care in the past two years on the survey; in discussions, 21 participants reported providing care in the past two years. Interpretations of BRFSS terminology varied greatly. Differences between age-related cognitive changes, dementia and Alzheimer\'s disease were unclear. Cognitive decline was largely understood in terms of identity loss and relationship changes with the affected individual, and how that individual\'s relationship changed within community. Caution is advised when using BRFSS data to frame messaging because key cognitive health terms are not universally understood. Messaging that apply the Africana Worldview centralizes relationships and community rather than impact on individual\'s day-to-day activities, may be more effective for Black/African Americans and for other groups with different cultural and life experiences.

UNASSIGNED: Emergency departments (EDs) are facing an epidemic of overcrowding and ED boarding, particularly of older adults who often present with, or develop, delirium in the ED. Delirium is associated with increased complications, longer hospital length of stay, mortality, and costs to the healthcare system. However, we only have limited knowledge of how to successfully prevent and treat delirium in the ED in a pragmatic, sustainable, and cost-effective way. We present a narrative review of recent literature of delirium prevention and treatment programs in the ED. We aim to describe the components of successful delirium management strategies to be used by EDs in building delirium management programs.
UNASSIGNED: We reviewed 10 studies (2005-2023) that report delirium interventions in the ED, and describe the different components of these interventions that have been studied. These interventions included: optimizing hemodynamics and oxygenation, treating pain, hydration and nutrition support, avoiding sedative hypnotics, antipsychotics and anticholinergics, promoting sleep, sensory stimulation, limiting the time spent in the ED, educating providers and staff, and developing multidisciplinary delirium protocols integrated into the electronic health record.
UNASSIGNED: Through our narrative review of the recent literature on delirium prevention and treatment programs in the ED, we have identified nine components of successful delirium prevention strategies in the ED. We also discuss three high priority areas for further research including identification of most effective components of delirium prevention strategies, conduct of additional high-quality trials in non-hip.

Introduction: At the end of life, the prevalence of delirium and pain is high. Current therapy is not satisfactory. Dexmedetomidine could be useful in the control of delirium and pain but is not approved outside of intensive care setting. Our objectives are to evaluate existing evidence in the literature that assessed the efficacy of dexmedetomidine in pain and delirium control and its safety in palliative care patients outside intensive care units. This systematic review was prospectively registered with PROSPERO and included a risk of bias assessment. Methods: PubMed and SCOPUS were examined for literature published until 2023. Experimental, cohort, cross-sectional, case-control studies, and case series/reports were included if they evaluate the use of dexmedetomidine in delirium and/or pain management in hospitalized palliative care adult patients. Studies were excluded if they were carried out in intensive care units. Results: Of the initial 529 records, 14 were included. Although only two studies were randomized trials, most were small and only one had low risk of bias. In most case reports and in the two retrospective cohort studies, dexmedetomidine appears to be a better option for these symptoms, although differences were not significant in the randomized trials. Discussion: Dexmedetomidine seems to be a promising option for refractory pain and delirium and may contribute to a reduction in opioid administration to control pain. This is the first systematic review of dexmedetomidine in palliative care. Quality evidence is limited, but clinical properties of dexmedetomidine justify the conduction of controlled trials in palliative care.

Fahr\'s disease is a rare neurodegenerative disorder with brain calcifications and neuropsychiatric symptoms. It can have variable phenotypic expression and intermittent symptomatology, making diagnosis challenging. In this report, we describe a young female patient presenting with symptoms of psychosis and confusion, which could be indicative of a delirium superimposed on the cerebral vulnerability associated with Fahr\'s disease. Notably, about two years prior, she experienced multiple episodes of tonic-clonic seizures that spontaneously resolved without pharmacological intervention. She had no previous psychiatric history. Following comprehensive investigations, other organic causes were ruled out, and Fahr\'s disease was diagnosed based on bilateral symmetrical brain calcifications seen on a head CT scan. Her treatment regimen encompassed antipsychotics and anticonvulsants. This case highlights the importance of considering Fahr\'s disease as a differential diagnosis in patients with new-onset neuropsychiatric symptoms. The case also explores the atypical early onset and intermittent nature of symptoms in the absence of a positive family history, highlighting the complexity of Fahr\'s disease. A multidisciplinary approach and regular follow-up are crucial for optimizing patient care and monitoring disease progression. Further research is needed to enhance our understanding of Fahr\'s disease and develop standardized treatment strategies for this rare condition.