Facilitators: Grace Thrall and Jane Gagliardi

Learning Objectives:

1. To become familiar with concepts encountered in articles dealing with Harm
2. To become comfortable interpreting results from Harm articles
3. To review and strengthen familiarity with concepts from earlier sessions

Class materials:

• Class Objectives (DOC)

• Clinical Scenario: Mrs. P is an 82 year old woman who is admitted to the hospital for elective total knee arthroplasty due to severe osteoarthritis. Her surgery is uncomplicated. On post-operative day #2, she has trouble falling asleep. The intern on call is paged and he orders diphenhydramine 25 mg po x1. Mrs. P was able to fall asleep after receiving this medication. The next day, her daughter visits and notes that Mrs. P is confused. She is more somnolent and has trouble paying attention to conversation with her daughter. She is also disoriented to time of day.

• Article: Agostini JV. Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients.
  Arch Intern Med. 2001 Sep 24;161(17):2091-7.

• Harm worksheet

• Critical Appraisal for Agostini article (DOC)

• 2x2 Tables (DOC)

• Statistics cheat sheet (PDF)

• Users' Guide to the Medical Literature Interactive
  Click on Access UGI -- Click on Part 1: The Basics -- Select 1B2: Harm and Select What are the results?