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Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation
Diachun, Laura; Charise, Andrea; Goldszmidt, Mark; Hui, Yin; Lingard, Lorelei
Background While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met "by random opportunity".(1) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity. Methods Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings' case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings' teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital. Results The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met. Conclusions More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity. PMID:25452825
Positioning Medical Students for the Geriatric Imperative: Using Geriatrics to Effectively Teach Medicine
ERIC Educational Resources Information Center
Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.
Medical schools must consider innovative ways to ensure that graduates are prepared to care for the aging population. One way is to offer a geriatrics clerkship as an option for the fulfillment of a medical school's internal medicine rotation requirement. The authors' purpose was to evaluate the geriatrics clerkship's impact on…
Emergency Medicine Clerkship Directors: Current Workforce
Wald, David A.; Khandelwal, Sorabh; Manthey, David E.; Way, David P.; Ander, Douglas S.; Thibodeau, Lorraine
Introduction The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director. Methods We developed and implemented a comprehensive questionnaire, and used it to survey all emergency medicine clerkship directors at United States allopathic medical schools accredited by the Liaison Committee on Medical Education. We analyzed and interpreted data using descriptive statistics. Results One hundred seven of 133 (80.4%) emergency medicine clerkship directors completed the survey. Clerkship Director's mean age was 39.7 years (SD-7.2), they were more commonly male 68.2%, of Caucasian racial backgrounds and at the instructor or assistant professor (71.3%) level. The mean number of years of experience as clerkship director was 5.5 (SD-4.5). The mean amount of protected time for clerkship administration reported by respondents was 7.3 hours weekly (SD-5.1), with the majority (53.8%) reporting 6 or more hours of protected time per week. However, 32.7% of emergency medicine clerkship directors reported not having any protected time for clerkship administration. Most clerkship directors (91.6%) held additional teaching responsibilities beyond their clerkship and many were involved in educational research (49.5%). The majority (79.8%), reported being somewhat or very satisfied with their job as clerkship director. Conclusion Most clerkship directors were junior faculty at the instructor or assistant professor rank and were involved with a variety of educational endeavors beyond the clerkship. PMID:25035743
Expectations of an emergency medicine clerkship director.
Rogers, Robert L; Wald, David A; Lin, Michelle; Zun, Leslie S; Christopher, Theodore; Manthey, David E
The clerkship director (CD) serves as a faculty leader within a school of medicine and plays a vital role in the hierarchy of undergraduate medical education. Collectively, CDs across specialties serve a multitude of roles and are responsible for clerkship administration, curricular development, teaching, mentoring, and advising students. The emergency medicine (EM) CD has a vitally important role to play in the future development of medical students. EM CDs should be valued and supported, because they often represent our specialty within the medical school and play a vital role in training the physicians of tomorrow. Opportunities and resources must be made available to CDs to run and maintain a successful EM clerkship, while also balancing their clinical duties and academic endeavors. In addition, EM CDs need support from their respective medical schools and departments to run highly successful medical student rotations. This article was prepared with the objective of establishing the importance of the EM CD, defining the job description of the CD, explaining the importance of adequate release time to perform the role of the CD, and describing the necessary resources and support for the position. With EM becoming an increasingly popular and integral rotation for medical students, it is likely that additional emphasis will be placed on the role of the EM CD. This reference document serves as a template for the job description and expectations of an EM CD. PMID:21521403
Internal Medicine Clerkship Inpatient Rotation
Issa, Naoum
Oral and Written Communication Professional Behavior OME NEW Medicine IR Mid Eval Did Not Observe Unacceptable Fair Good Excellent Outstanding 9. Demonstrates reliability and professional responsibility Diagnosis and Management in Internal Medicine 1. Applies clinical knowledge in conducting a thorough history
Emergency medicine clerkship curriculum: an update and revision.
Manthey, David E; Ander, Douglas S; Gordon, David C; Morrissey, Tom; Sherman, Scott C; Smith, Michael D; Rimple, Diane; Thibodeau, Lorraine G
In 2006, the latest version of a national curriculum for the fourth-year emergency medicine (EM) clerkship was published. Over the past several years, that curriculum has been implemented across multiple clerkships. The previous curriculum was found to be too long and detailed to cover in 4 weeks. As well, updates to the Liaison Committee on Medical Education (LCME)'s form and function document, which guides the structure of a clerkship, have occurred. Combining experience, updated guidelines, and the collective wisdom of members of the national organization of the Clerkship Directors in Emergency Medicine (CDEM), an update and revision of the fourth-year EM clerkship educational syllabi has been developed. PMID:20624144
Geriatrics Equals Multiplex Medicine
Gryfe, C. I.
Diseases increase in frequency with advancing age but clinical methods of recognizing them do not appear to keep pace. The complex interrelationship of multiple disease processes and their management confounds traditional diagnostic and therapeutic tactics, demanding a systematic approach for understanding and effectiveness. Problem orientation, rather than diagnostic formulation and steriotyped therapy, allows a practical approach to unravelling geriatric multiplexity. PMID:20469004
[Review in geriatric medicine].
Jabri, A; Rodondi, A; Eyer, S; Doser, N; Monod, S; Gold, G; Büla, C; Rochat, S
In 2010, a study emphasizes the difficulty to predict disability trajectories in the last year of life. A meta analysis shows the effectiveness of post-acute geriatric rehabilitation in reducing functional decline after hospitalisation. Several studies evaluated pneumococcal and herpes zoster vaccines' efficacy. A short and simple intervention is effective in reducing benzodiazepine use. The effect of vitamine D on falls and fractures has been further evaluated in several studies. Diagnostic criteria for dementias, including Alzheimer's disease, are moving to better acknowledge their preclinical stages. PMID:21309171
Grade Inflation and the Internal Medicine Subinternship: A National Survey of Clerkship Directors
Suzanne M. Cacamese; Michael Elnicki; Alice J. Speer
Background: Grade inflation has been demonstrated in certain medical school clerkships but never studied in the internal medicine subinternship.Purposes: The purpose is to determine the existence, extent, and possible causes of subinternship grade inflation.Methods: We surveyed clerkship directors as part of the 2004 Clerkship Directors in Internal Medicine national member survey.Results: The majority of clerkship directors agree that subinternship grade
Mandatory clerkship in physical medicine and rehabilitation: Effect on medical students' knowledge of physiatry
Steven C. Kirshblum; Joel A. Delisa; Denise L Campagnolo
Objective: To study the effect of a 2-week clerkship on the perceptions and knowledge of physical medicine and rehabilitation (PM&R) among fourth-year medical students.Design: Survey of fourth-year medical students before and after completion of a mandatory clerkship.Results: Knowledge of PM&R by fourth-year medical students is marginal, but a clerkship increases the awareness of the practice of physiatry.Conclusions: Mandatory clerkships can
Consensus Development of a Pediatric Emergency Medicine Clerkship Curriculum
Askew, Kim L.; Weiner, Debra; Murphy, Charles; Duong, Myto; Fox, James; Fox, Sean; O'Neill, James C.; Nadkarni, Milan
Introduction As emergency medicine (EM) has become a more prominent feature in the clinical years of medical school training, national EM clerkship curricula have been published to address the need to standardize students' experiences in the field. However, current national student curricula in EM do not include core pediatric emergency medicine (PEM) concepts. Methods A workgroup was formed by the Clerkship Directors in Emergency Medicine and the Pediatric Interest Group of the Society of Academic Emergency Medicine to develop a consensus on the content to be covered in EM and PEM student courses. Results The consensus is presented with the goal of outlining principles of pediatric emergency care and prioritizing students' exposure to the most common and life-threatening illnesses and injuries. Conclusion This consensus curriculum can serve as a guide to directors of PEM and EM courses to optimize PEM knowledge and skills education. PMID:25247034
Hospitalist workload influences faculty evaluations by internal medicine clerkship students
Robinson, Robert L
Background The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. Design A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Participants Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Measures Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Results Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. Conclusion The results suggest that internal medicine clerkship student evaluations of hospitalist faculty are negatively influenced by high clinical service intensity measured in terms of annual work RVUs, patient encounters, and duty days. PMID:25709514
Emergency Medicine Clerkship MID-ROTATION EVALUATION
Issa, Naoum
Behavior Did Not Observe Observer Reporter Interpreter Manager Educator 9. Demonstrates reliability's Performance Professionalism: Communications with patients, faculty, peers and ancillary staff: Clinical in Emergency Medicine 1. Applies clinical knowledge in conducting a focused and time appropriate history
?lgili, Önder; Arda, Berna; Munir, Kerim
This article aims to evaluate the research process in geriatrics from the ethical point of view. The elderly population is increasing rapidly, but there is no parallel in the amount of research concerning this demographic. On the other hand, in the light of research ethics, this group mainly represents vulnerable people and requires more sensitivity. Taking into account all these features, fundamental principles in research ethics are first considered: the soundness of the scientific project, qualifications of the investigators, ethics committee approval, informed consent, confidentiality and privacy, beneficence/nonmaleficence, and justice are evaluated. Special ethical issues in geriatric research such as ageism and research inclusion, paucity of research involving elderly people, vulnerability of elderly subjects, and cognitive impairments are discussed separately. PMID:25489272
Re-demonstration without remediation – a missed opportunity? A national survey of internal medicine clerkship directors
Hawthorne, Mary R.; Chretien, Katherine C.; Torre, Dario; Chheda, Shobhina G.
Background Many different components factor into the final grade assigned for the internal medicine clerkship. Failure of one or more of these requires consideration of remedial measures. Purpose To determine which assessment components are used to assign students a passing grade for the clerkship and what remediation measures are required when students do not pass a component. Methods A national cross-sectional survey of Clerkship Directors in Internal Medicine (CDIM) institutional members was conducted in April 2011. The survey included sections on remediation, grading practices, and demographics. The authors analyzed responses using descriptive and comparative statistics. Results Response rate was 73% (86/113). Medicine clerkships required students to pass the following components: clinical evaluations 83 (97%), NBME subject exam 76 (88%), written assignments 40 (46%), OSCE 35 (41%), in-house written exam 23 (27%), and mini-CEX 19 (22%). When students failed a component of the clerkship for the first time, 55 schools (64%) simply allowed students to make up the component, while only 16 (18%) allowed a simple make-up for a second failure. Additional ward time was required by 24 schools (28%) for a first-time failure of one component of the clerkship and by 49 (57%) for a second failure. The presence or absence of true remedial measures in a school was not associated with clerkship director academic rank, grading scheme, or percent of students who failed the clerkship in the previous year. Conclusions Most schools required passing clinical evaluations and NBME subject exam components to pass the medicine clerkship, but there was variability in other requirements. Most schools allowed students to simply re-take the component for a first-time failure. This study raises the question of whether true remediation is being undertaken before students are asked to re-demonstrate competence in a failed area of the clerkship to be ready for the subinternship level. PMID:25500150
[Review in geriatric medicine 2014].
Nguyen, Sylvain; Smith, Cindi; Gold, Gabriel; Major, Kristof; Rubli, Eve; Büla, Christophe
Several studies contributed to improving the diagnostic and prognostic assessment of delirium in hospitalized older patients. Direct patient education proved efficient in benzodiazepines withdrawal. A position statement of the American Geriatrics Society does not recommend tube feeding when eating difficulties arise in older persons suffering from advanced dementia. Several studies emphasized once again the potential importance of preventative interventions (in particular physical activity) to prevent or delay dementia occurrence. Two randomized controlled trials of monoclonal antibodies that bind amyloid did not show benefit in patients with mild-to-moderate Alzheimer's dementia (AD). In contrast, vitamin E reduced functional decline in these patients, and citalopram reduced agitation among AD patients as well as their caregiver's stress. PMID:25799653
Berdichevsky, Victor
SUBJECT EXAM TESTING DATES BY CLERKSHIP -2012-2013 FAMILY MEDICINE NEUROLOGY PEDIATRICS PSYCHIATRY SUBJECT EXAM SCHEDULE 8:00 AM Â Pediatrics, Family Medicine, Psychiatry and Surgery 11:00 AM Â Medicine
Emergency medicine clerkship: a joining of private-practice referral veterinary medicine with an academic institution.
Olson, Sonja A
Novel approaches to the clinical training of veterinary students in many disciplines are being sought by veterinary colleges. In 2004, the University of Florida College of Veterinary Medicine approached the Small Animal Department and Florida Veterinary Specialists (FVS) in Tampa with a proposal to jointly design and run an elective clerkship in emergency medicine. The program would focus on providing increased emergency case exposure in a real-world environment to interested third- and fourth-year veterinary students. The purpose would be to better prepare these students for emergent cases while increasing their overall level of clinical confidence. This article reviews in detail the clerkship structure, its objectives, and the logistics of training and support at FVS. In this instance, the academic-private institution partnership has been successful in providing effective learning for veterinary students over the last three years. This clerkship structure may serve as a template for other institutions exploring alternatives to the traditional clinical training of veterinary students. PMID:18339953
A Reflection on Aging: A Portfolio of Change in Attitudes toward Geriatric Patients during a Clerkship Rotation
ERIC Educational Resources Information Center
Del Duca, Danny; Duque, Gustavo
The process of students' evaluation in medical schools has changed from a tutor-led evaluation system based on students' performance to a student-based evaluation that involves self-reflection and their level of change in skills and attitudes. At the McGill University Division of Geriatric Medicine, we developed an innovative system of evaluation…
A Third-Year Family Medicine Clerkship Based in an Academic Family Practice Center.
ERIC Educational Resources Information Center
Taylor, Robert B; And Others
A 5-week family medicine clerkship is described that uses several innovative techniques: problem-based learning focusing on patient management tutorials; consultation with specialists; supervised patient care and a nursing home inpatient teaching service; and workshops on topics such as office-surgical techniques, practice management, and…
A manageable approach to integrating personal digital assistants into a family medicine clerkship
Julie Scott Taylor; David Anthony; Laura K. Lavallee; Nathaniel L. Taylor
Personal digital assistants (PDAs) were incorporated into the six-week Family Medicine Clerkship in 2002 to achieve two major goals: tracking students' outpatient encounters at preceptor sites and providing opportunities to use PDAs during medical visits. Each student collects information on each patient seen. Data are then retrieved and presented to students individually and as a group twice during the rotation.
Improving the National Board of Medical Examiners Internal Medicine Subject Exam for Use in Clerkship Evaluation
Elnicki, D Michael; Lescisin, Dianne A; Case, Susan
OBJECTIVE To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN Two-round Delphi technique. PARTICIPANTS The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS Using 1–5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM–CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4.0), and for individual students (3.8). CONCLUSION Clerkship directors identified test content that was relevant to the curricular content and important for clerkship students to know, and they indicated a desired question distribution. They would most like feedback on their students' performance by organ system–based sections for the complete academic year. This collaborative effort could serve as a model for aligning national exams with course goals. PMID:12133157
Caring for older Americans: the future of geriatric medicine.
Besdine, Richard; Boult, Chad; Brangman, Sharon; Coleman, Eric A; Fried, Linda P; Gerety, Meghan; Johnson, Jerry C; Katz, Paul R; Potter, Jane F; Reuben, David B; Sloane, Philip D; Studenski, Stephanie; Warshaw, Gregg
In response to the needs and demands of an aging population, geriatric medicine has grown rapidly during the past 3 decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons: To ensure that every older person receives high-quality, patient-centered health care; To expand the geriatrics knowledge base; To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons; To recruit physicians and other healthcare professionals into careers in geriatric medicine; To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors. Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics. PMID:15963180
University of Wisconsin School of Medicine and Public Health Course Title: Extramural Elective Clerkship in International Health
Sheridan, Jennifer
University of Wisconsin School of Medicine and Public Health Course Title: Extramural Elective Clerkship in International Health Department/ Course Number: Senior Medicine #882-937 Offered: Semesters I may include public health, prevention, and health education activities. Placements will be approved
Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents
Hogan, Teresita M.; Hansoti, Bhakti; Chan, Shu B.
Introduction Emergency care of older adults requires specialized knowledge of their unique physiology, atypical presentations, and care transitions. Older adults often require distinctive assessment, treatment and disposition. Emergency medicine (EM) residents should develop expertise and efficiency in geriatric care. Older adults represent over 25% of most emergency department (ED) volumes. Yet many EM residencies lack curricula or assessment tools for competent geriatric care. Fully educating residents in emergency geriatric care can demand large amounts of limited conference time. The Geriatric Emergency Medicine Competencies (GEMC) are high-impact geriatric topics developed to help residencies efficiently and effectively meet this training demand. This study examines if a 2-hour didactic intervention can significantly improve resident knowledge in 7 key domains as identified by the GEMC across multiple programs. Methods A validated 29-question didactic test was administered at six EM residencies before and after a GEMC-focused lecture delivered in summer and fall of 2009. We analyzed scores as individual questions and in defined topic domains using a paired student t test. Results A total of 301 exams were administered; 86 to PGY1, 88 to PGY2, 86 to PGY3, and 41 to PGY4 residents. The testing of didactic knowledge before and after the GEMC educational intervention had high internal reliability (87.9%). The intervention significantly improved scores in all 7 GEMC domains (improvement 13.5% to 34.6%; p<0.001). For all questions, the improvement was 23% (37.8% pre, 60.8% post; P<0.001) Graded increase in geriatric knowledge occurred by PGY year with the greatest improvement post intervention seen at the PGY 3 level (PGY1 19.1% versus PGY3 27.1%). Conclusion A brief GEMC intervention had a significant impact on EM resident knowledge of critical geriatric topics. Lectures based on the GEMC can be a high-yield tool to enhance resident knowledge of geriatric emergency care. Formal GEMC curriculum should be considered in training EM residents for the demands of an aging population. PMID:25035745
Analysis and Publication Rates of Clerkship Directors in Internal Medicine (CDIM) Annual Meeting Abstracts 1995–2005
Klara K. Papp; Elizabeth A. Baker; Liselotte N. Dyrbye; D. Michael Elnicki; Paul A. Hemmer; Alex J. Mechaber; Matthew Mintz; Steven J. Durning
Background: Abstracts presented at meetings may be a reflection of the meeting's quality. Summary: The goal is to determine purpose, content areas, research design, and subsequent publication rates of abstracts presented at Clerkship Directors in Internal Medicine's annual meetings. Abstracts presented in 1995–2005 were analyzed. A total of 201 abstracts were analyzed and coded. The purpose of the majority of
Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship
Lamba, Sangeeta; Nagurka, Roxanne; Offin, Michael; Scott, Sandra R.
Introduction The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship. Methods We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma) with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why) to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17%) and poor prognosis (34/120, 29%). This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much) for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real) generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and competence in communicating difficult news of death and poor prognosis to family. Educators may need to seek ways to address the strong emotions generated in learners with real and simulated patient resuscitations. PMID:25834685
[Geriatric medicine and long-term care insurance].
Sakurai, Takashi; Song, Xiuzhen; Yokono, Koichi
Long-term care insurance (LCI) started from April 2000 in Japan. LCI now occupies a central position in the health care of the aged. We reviewed all original papers and reports on LCI published in 1996-2002. At the end of 2002, we searched for papers on LCI in a computer database using the keyword of LCI, and found 3,606 papers. Authors and contents of each paper were categorized using 54 kinds of keywords. Frequent authors were government agencies, care managers, physical therapists, and physicians. When we analyzed these papers according to the places where LCI was used, more than 50% of reports concerned LCI at home. Most frequent keywords were Government/LCI system. Regional health, Physician' assessment and grades for care. Care management, Care manager, and Rehabilitation. Care manager was less observed after the start of LCI. In contrast, the use of keywords including Care service. Dementia, Geriatric syndrome, Nurse, Institutional medicine, Hospital care, Medicine for the aged, Terminal care, Dialysis therapy, Abuse of the aged, and Caregiver burden were increased after LCI. At the beginning of LCI, main concerns are on the new LCI system. However, more individual issues in the care of the aged are now discussed. New issues such as Abuse of the aged and Caregiver burden have been recently raised. From these observations, the role of geriatric medicine seems also to be changing after the induction of LCI. We would now contribute actively to crucial aspects of LCI, such as comprehensive assessment of the aged, functional medical network with care staffs, and new therapeutic approaches to each geriatric syndrome. PMID:15148754
Complexity in graduate medical education: a collaborative education agenda for internal medicine and geriatric medicine.
Chang, Anna; Fernandez, Helen; Cayea, Danelle; Chheda, Shobhina; Paniagua, Miguel; Eckstrom, Elizabeth; Day, Hollis
Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients. PMID:24557513
Puglisi, Joseph
Policies pertinent to clerkship education · Definition of the medical student decision-making PATIENT CARE 1. Conduct a thorough, accurate, and patientMEDICINE OFFICE OF MEDICAL EDUCATION CLERKSHIP EDUCATOR
Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)
ERIC Educational Resources Information Center
Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.
A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…
Geriatric medicine leadership of health care transformation: to be or not to be?
Heckman, George A; Molnar, Frank J; Lee, Linda
Geriatric Medicine is well-suited to inform and lead health-care system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to "brand" Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system. PMID:24278096
UWSOM FAMILY MEDICINE CLERKSHIP Grading Criteria (2012-13 Academic Year)
Maxwell, Bruce D.
at least ten (10) scores of 5 and no score less than a 4 in any category for Honors. 2. High Pass Students Pass. 3. Pass The Pass grade reflects the performance of a student at the expected level for a third year clerkship student. 4. Fail A failing grade is based on student's performance taken as a whole
European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique
Masud, Tahir; Blundell, Adrian; Gordon, Adam Lee; Mulpeter, Ken; Roller, Regina; Singler, Katrin; Goeldlin, Adrian; Stuck, Andreas
Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe. PMID:24603283
Salvaging a geriatric medicine academic program in disaster mode-the LSU training program post-Katrina.
Cefalu, Charles A.; Schwartz, Robert S.
Formal training in geriatric medicine in Louisiana is in its infancy. This article portrays the struggle of the sole functioning geriatric medicine training program and its trials and tribulations in a survival mode, opportunities that come with disaster as well as lessons learned post-Katrina. PMID:17534025
Developing future nursing home medical directors: a curriculum for geriatric medicine fellows.
Higuchi, Masaya; Wen, Aida; Masaki, Kamal
Long term care facilities are important sites of care for elderly adults. Despite a growing need and interest in medical direction in nursing homes, there have been limited educational opportunities in this area for geriatric medicine fellows. This article describes a novel medical director's curriculum for first-year geriatric medicine fellows to prepare them for the role of nursing home medical director. This novel curriculum has been integrated into the Department of Geriatric Medicine's Fellowship training program at the John A. Burns School of Medicine, University of Hawaii. The curriculum consists of seven seminars that have been integrated into the didactic sessions during the first year of fellowship. Core content areas include: (1) roles and responsibilities of the medical director, (2) infection control, (3) physician documentation, (4) federal regulations and state surveys, (5) quality improvement, (6) culture change in nursing homes, and (7) transitions in care. All topics were discussed using the framework described by the American Medical Directors Association's position statement on the roles and responsibilities of the nursing home medical director. To our knowledge, this is the first curriculum in the medical literature that is designed to prepare geriatric medicine fellows for roles as medical directors in nursing homes. PMID:23168110
The Roots of Geriatric Medicine: Care of the Aged in Byzantine Times (324–1453 AD)
J. Lascaratos; Effie Poulacou-Rebelacou
Background: The search for the roots of geriatric medicine, which has been considered a relatively new branch. Objective: The purpose of the study is the research of the original Byzantine medical texts and the contemporary historical sources so as to bring to light knowledge about ancient medical care. Methods: The medical texts of Byzantine physicians were studied and analysed, as
Geriatrics and physical medicine and rehabilitation: Common principles, complementary approaches, and 21st century demographics
Dale C. Strasser; David H. Solomon; John R. Burton
Strasser DC, Solomon DH, Burton JR. Geriatrics and physical medicine and rehabilitation: common principles, complementary approaches, and 21st century demographics. Arch Phys Med Rehabil 2002;83:1323-4. The demographic changes occurring in the United States transcend the capabilities of any specific medical specialty to provide optimum care for the elderly. This commentary discusses a statement of principles drafted by representatives of the
Axioms, osteopathic culture, and a perspective from geriatric medicine.
Noll, Donald R; Sthole, Havilah Julia; Cavalieri, Thomas A
Osteopathic medicine is a rapidly growing discipline in health care that has much to offer the wider biomedical community. A distinction of the osteopathic medical profession is the importance of an overall guiding philosophy. Despite the osteopathic medical profession's success, there remains concern about the profession's ability to maintain its unique identity. Among many factors that have contributed to the profession's success, certain axioms from its earliest days are pertinent to the profession's identity. Maintaining a knowledge and appreciation of osteopathic axioms can play an important role in safeguarding the profession's identity. These axioms encapsulate osteopathic philosophy and, moreover, are universally useful for patient care. As osteopathic geriatricians, the authors explore the value and meaning of these axioms for anyone who treats patients, but especially for the care of the elderly. The authors also propose a new axiom, derived from the experience of 2 of the authors: "First try to blame it on the medications." PMID:24285033
Senecal, Emily L; Askew, Kim; Gorney, Barbara; Beeson, Michael S; Manthey, David E
Written examinations are frequently used to assess medical student performance. Within emergency medicine (EM), a National Board of Medical Examiners (NBME) subject examination for EM clerkships does not exist. As a result, clerkship directors frequently generate examinations within their institution. This article reviews the literature behind the use of standardized examinations in evaluating medical student performance, describes methods for generating well-written test questions, reviews the statistical concepts of reliability and validity that are necessary to evaluate an examination, and proposes future directions for testing EM students. PMID:21199081
Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process
Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.
Background The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. PMID:20370765
Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship
Lamba, Sangeeta; Nagurka, Roxanne; Offin, Michael; Scott, Sandra R.
Development and mededportal.org/publication/9367 (2013). evaluation of a palliative medicine curriculumcurriculum design. Self-reflection exercises have also been shown to foster developmentdevelopment and 2) analyze these written learner experiences with the goal to inform future case scenario and curriculum
Role of complementary and alternative medicine in geriatric care: A mini review
Siddiqui, Mohammad Jamshed; Min, Chan Sze; Verma, Rohit Kumar; Jamshed, Shazia Qasim
Since time immemorial homo sapiens are subjected to both health and diseases states and seek treatment for succor and assuagement in compromised health states. Since last two decades the progressive rise in the alternative form of treatment cannot be ignored and population seems to be dissatisfied with the conventional treatment modalities and therefore, resort to other forms of treatment, mainly complementary and alternative medicine (CAM). The use of CAM is predominantly more popular in older adults and therefore, numerous research studies and clinical trials have been carried out to investigate the effectiveness of CAM in the management of both communicable and non-communicable disease. In this current mini review, we attempt to encompass the use of CAM in chronic non-communicable diseases that are most likely seen in geriatrics. The current review focuses not only on the reassurance of good health practices, emphasizing on the holistic development and strengthening the body's defense mechanisms, but also attempts to construct a pattern of self-care and patient empowerment in geriatrics. The issues of safety with CAM use cannot be sidelined and consultation with a health care professional is always advocated to the patient. Likewise, responsibility of the health care professional is to inform the patient about the safety and efficacy issues. In order to substantiate the efficacy and safety of CAMs, evidence-based studies and practices with consolidated standards should be planned and executed. PMID:25125879
Mindfulness: Reconnecting the Body and Mind in Geriatric Medicine and Gerontology
Rejeski, W. Jack
Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the context of geriatric medicine and gerontology. Upon reviewing definitions and models of the concept, I give attention to the unique role that the body plays in cultivating mindfulness and the advantages that this focus has for older adults because they have aging biological systems and may experience chronic disease, pain, and disability. In the final section I discuss why mindfulness may be particularly useful in promoting physical activity among older adults and how physical activity may be used as a vehicle to promote mindfulness. PMID:18483425
Effect of a new longitudinal interprofessional geriatric medicine educational track on knowledge and attitude of medical students: a controlled cohort study.
Koh, Gerald C H; Ling, Carolyn L H; Ma, Bosco H M; Chen, Cynthia; Lim, Wee Shiong; Scherer, Samuel C; Amin, Zubair; Merchant, Reshma A
A new interprofessional geriatric medicine curriculum was recently introduced at a large undergraduate Asian medical school. A longitudinal controlled interventional cohort study was conducted to evaluate the effect of the new curriculum on the knowledge and attitudes of medical students. The medical students under the new curriculum formed the intervention cohort, and those under the former curriculum formed the control cohort. To test knowledge, the University of California at Los Angeles (UCLA) geriatrics knowledge test (GKT) was used in Year 2 and the University of Michigan GKT in Year 5. Geriatrics attitudes were evaluated using the UCLA geriatrics attitudes test in Years 2 and 5. Not surprisingly, geriatrics knowledge at the end of Year 5 of medical school was enhanced to a greater degree in the intervention cohort than the control cohort, although improvements in geriatrics attitudes in each cohort were of similar magnitude by the end of Year 5, suggesting that factors other than a formal geriatrics curriculum influenced the improvements in geriatrics attitudes. This article is one of few published on the effectiveness of geriatrics curricular innovations using validated knowledge and attitude outcomes in a longitudinal controlled study design and will be useful to other medical institutions seeking to improve the geriatrics knowledge and attitudes of their students. PMID:25732398
Use of Admissions Interview Comments to Predict Clinical Clerkship Success.
ERIC Educational Resources Information Center
Baker, Helen Hicks; Dunlap, Margaret Reed
The use of admission interview comments to predict clinical clerkship success of medical students was evaluated. Narrative comments made by admissions interviewers regarding an applicant's skills and attitudes were coded, as were narrative evaluations of these students during year III of required clerkships in pediatrics and internal medicine in…
The Practice of Geriatrics: Specialized Geriatric Programs and Home Visits
Hogan, David B.
Home visits have a long history in geriatrics. In this narrative review, the literature on home visits performed by specialists in geriatric medicine (or psychiatry) and/or specialized programs in geriatric medicine (or psychiatry) published between January 1988 and December 2008 was examined. The papers reviewed were few and inconsistent in their message. The lessons that can be derived from them are limited. Draft recommendations about the role of home visiting by specialized geriatric programs in Canada are presented. PMID:23251306
Geriatrics: Profiles in Geriatrics
... who are the history of our nation." Accepting the American Geriatrics Society's Clinician of the Year Award in ... MD, who took the helm as president of the American Geriatrics Society in April, got her start in ...
Geriatric rehabilitation. 4. Physical medicine and rehabilitation interventions for common age-related disorders and geriatric syndromes 1? 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is\\/are associated. ? Key references
Edward M Phillips; Carol F Bodenheimer; Randolph L Roig; David X Cifu
Phillips EM, Bodenheimer CF, Roig RL, Cifu DX. Geriatric rehabilitation. 4. Physical medicine and rehabilitation interventions for common age-related disorders and geriatric syndromes. Arch Phys Med Rehabil 2004;85(Suppl 3):S18–22.This self-directed learning module highlights physical medicine and rehabilitation (PM&R) interventions for age-related physiologic changes. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for
Transitioning between Clerkship Directors
ERIC Educational Resources Information Center
Soltys, Stephen M.; Pary, Robert J.; Robinson, Stephen W.; Markwell, Stephen J.
Objective: The authors report on succession-planning for mid-level academic positions. Method: The authors describe the process of succession-planning between clerkship directors and the smooth transition resulting in one case. Results: Gradually transitioning allowed a new faculty person to assume the clerkship-director position with minimal…
The Surgical Clerkship in the Community Hospital
ERIC Educational Resources Information Center
Dean, Richard E.; Johnson, Tom M.
Since 1972 Michigan State University College of Human Medicine has participated with community hospitals and practicing physicians in a number of cities to provide surgical clerkship experiences for its students. The new role of a full-time community-based university surgeon to facilitate this program is described. (Author/LBH)
Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine
Fuchs, Stephan; Klement, Andreas; Lichte, Thomas; Abendroth, Jens
Introduction: With the amendment of the medical licensure act (Approbationsordnung) in 2012, a four-week clerkship in primary care (FHV) became mandatory. We investigated the expectations with which students begin the FHV, which criteria are relevant in selecting the location for the FHV, and the experiences the students had during the FHV. Method: In a cross-sectional study, all third-year students at both medical schools in Saxony-Anhalt were surveyed in 2013 about their expectations and experiences regarding the FHV. This is the last cohort for which the FHV is optional. Questions were asked about 29 items addressing six topics (personal information, selection of FHV location, selection of FHV medical practice, expectations, experiences, and specialty selection). Results: Out of a student body of 446, responses were received from N=424 (response rate 95.1%; of which 61.8% female). Of these students, 71 (16.7%) had completed the FHV and 70 (16.5%) were planning to; another 267 students (63%) had not (yet) planned to participate in an FHV. Where a student's parents lived, personal recommendations of a particular medical practice and the attractiveness of the region were the most important criteria for selecting the clerkship site. After completing the FHV, the learning objectives reflected themselves in the experiences of the students in a similar order and significance as in the expectations of students who planned or had not (as of yet) planned to complete the FHV. A relevant influence of the FHV confirming the choice to specialize in general practice or outpatient care was not indicated by those who had completed the FHV. Conclusion: After location and practice, the FHV is selected according to personal criteria and in connection with prioritized learning objectives. From the students' perspective, the most frequently named learning objectives are also identified as acquired experience after completing the FHV. However, the FHV does not have a reinforcing effect on the selection of general practice as a specialty. PMID:25489344
Comprehensive Family Practice Clerkship in a Minority Institution
Bang, Ki Moon; Greene, E. Josephine; Williams, Henry W.; Leath, Brenda A.; Matthews, Ruth
A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas. PMID:3246700
A Strategy to Standardize the Learning of Core Clerkship Objectives
Karen E. Hauer; Arianne Teherani; Jeff Wiese; Cynthia L. Fenton
Background: Consistent and effective implementation of clinical clerkship objectives remains elusive. Using the behavioral principles\\u000a of self assessment, active learning and learner differences, we designed an objectives checklist to ensure that all students\\u000a mastered a core body of internal medicine (IM) knowledge and to facilitate self-directed learning. Methods: We developed a 54-item learning objectives checklist card in the IM clerkship.
"Making the grade:" noncognitive predictors of medical students' clinical clerkship grades.
Lee, Katherine B.; Vaishnavi, Sanjeev N.; Lau, Steven K. M.; Andriole, Dorothy A.; Jeffe, Donna B.
OBJECTIVES: Because clinical clerkship grades are associated with resident selection and performance and are largely based on residents'/attendings' subjective ratings, it is important to identify variables associated with clinical clerkship grades. METHODS: U.S. medical students who completed > or =1 of the following required clinical clerkships--internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology and psychiatry--were invited to participate in an anonymous online survey, which inquired about demographics, degree program, perceived quality of clerkship experiences, assertiveness, reticence and clerkship grades. RESULTS: A total of 2395 medical students (55% women; 57% whites) from 105 schools responded. Multivariable logistic regression models identified factors independently associated with receiving lower clerkship grades (high pass/pass or B/C) compared with the highest grade (honors or A). Students reporting higher quality of clerkship experiences were less likely to report lower grades in all clerkships. Older students more likely reported lower grades in internal medicine (P = 0.02) and neurology (P < 0.001). Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001); Asians more likely reported lower grades in obstetrics/gynecology (P = 0.007), pediatrics (P = 0.01) and neurology (P = 0.01). Men more likely reported lower grades in obstetrics/gynecology (P < 0.001) and psychiatry (P = 0.004). Students reporting greater reticence more likely reported lower grades in internal medicine (P = 0.02), pediatrics (P = 0.02) and psychiatry (P < 0.05). Students reporting greater assertiveness less likely reported lower grades in all clerkships (P < 0.03) except IM. CONCLUSIONS: The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation. PMID:17987918
Integrating Geriatrics into Medical School: Student Journaling as an Innovative Strategy for Evaluating Curriculum
ERIC Educational Resources Information Center
Shield, Renee R.; Farrell, Timothy W.; Nanda, Aman; Campbell, Susan E.; Wetle, Terrie
Purpose of the study: The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer…
... people who have the most complicated medical and social problems. Geriatrics: The Team Approach Geriatrics is known for ... psychiatrist These professionals evaluate the older person's medical, ... and managing multiple chronic conditions and medications. The ...
[Emergency medicine after a catastrophic disaster: from a view of geriatrics and gerontology].
Okinaga, Shoji; Daito, Hisayoshi; Suzuki, Motoi; Shiihara, Jun; Arai, Hiroyuki
The megathrust earthquake and the towering tsunami hit the east coast of Japan on March 11th of 2011 after intervals of 1,142 years. About 90 % of nearly 20,000 victims were drowned in devastating waves, while every town and city along the coast turned out to be a ruin. Over 400,000 people were forced to move to the evacuation centers where the evacuees slept on the floor without electricity, running water or heating systems at freezing nights. Emergency medicine, therefore, was more required during the evacuation phase than during the acute phase of the tsunami disaster. Here discussed is the phenomenon that the events happened mostly to the elderly evacuees especially in the swept area by silty polluted seawater. PMID:23855220
Effects and feasibility of an Integrative Medicine program for geriatric patients–a cluster-randomized pilot study
Teut, Michael; Schnabel, Katharina; Baur, Roland; Kerckhoff, Annette; Reese, Frauke; Pilgram, Niels; Berger, Franziska; Luedtke, Rainer; Witt, Claudia M
Background Older adults often use complementary medicine; however, very few interventional studies have focused on them. The aim of this study was to evaluate the feasibility and to obtain preliminary data on effectiveness of an Integrative Medicine (IM) program compared to usual medical care. Methods The study consisted of older adults living in shared apartment communities including caregiving. The shared apartments were cluster-randomized to the IM program or Usual Care (UC). IM consisted of additional lifestyle modification (exercise and diet), external naturopathic applications, homeopathic treatment, and modification of conventional drug therapy for 12 months. The UC group received conventional care alone. The following outcomes were used: Nurses Observation Scale for Geriatric Patients (NOSGER); Assessment of Motor and Process Skills; Barthel Index; Qualidem; Profile of Wellbeing; and Mini-mental State Examination. Exploratory effect sizes (Cohen's d, means adjusted for differences of baseline values) were calculated to analyze group differences. Results A total of eight shared apartment communities were included; four were allocated to IM (29 patients, median seven patients; [mean ± standard deviation] 82.7 ± 8.6 years) and four to UC (29 patients, median eight patients; 76.0 ± 12.8 years of age). After 12 months, effect sizes ?0.3 were observed for activities of daily living on the NOSGER-Activities of Daily Living subscale (0.53), Barthel Index (0.30), Qualidem total sum score (0.39), Profile of Wellbeing (0.36), NOSGER-Impaired Social Behavior (0.47), and NOSGER-Depressed Mood subscales (0.40). Smaller or no effects were observed for all other outcomes. The intervention itself was found to be feasible, but elaborate and time consuming. Discussion This exploratory pilot study showed that for a full-scale trial, the outcomes of Activities of Daily Living and Quality of Life seem to be the most promising. The results have to be interpreted with care; larger confirmatory trials are necessary to validate the effects. PMID:23901266
Gender-based education during clerkships: a focus group study
van Leerdam, Lotte; Rietveld, Lianne; Teunissen, Doreth; Lagro-Janssen, Antoine
Objectives One of the goals of the medical master's degree is for a student to become a gender-sensitive doctor by applying knowledge of gender differences in practice. This study aims to investigate, from the students' perspective, whether gender medicine has been taught in daily practice during clerkship. Methods A focus group study was conducted among 29 medical students from Radboud University, Nijmegen, The Netherlands, who had just finished either their internal medicine or surgical clerkships. Data were analyzed in line with the principles of constant comparative analysis. Results Four focus groups were conducted with 29 participating students. Clinical teachers barely discuss gender differences during students' clerkships. The students mentioned three main explanatory themes: insufficient knowledge; unawareness; and minor impact. As a result, students feel that they have insufficient competencies to become gender-sensitive doctors. Conclusion Medical students at our institution perceive that they have received limited exposure to gender-based education after completing two key clinical clerkships. All students feel that they have insufficient knowledge to become gender-sensitive doctors. They suppose that their clinical teachers have insufficient knowledge regarding gender sensitivity, are unaware of gender differences, and the students had the impression that gender is not regarded as an important issue. We suggest that the medical faculty should encourage clinical teachers to improve their knowledge and awareness of gender issues. PMID:24600301
Integrating Geriatric Content into a Medical School Curriculum: Description of a Successful Model
ERIC Educational Resources Information Center
Newell, Debra A.; Raji, Mukaila; Lieberman, Steven; Beach, Robert E.
Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center…
The Making of Careers, the Making of a Discipline: Luck and Chance in Migrant Careers in Geriatric Medicine
ERIC Educational Resources Information Center
Bornat, Joanna; Henry, Leroi; Raghuram, Parvati
The geriatric specialty, unpopular among most UK born and trained medical graduates, provided an opportunity for career development and achievement for those doctors whose training had been non-standard for a variety of reasons. Migrant doctors who have played a substantive role in the UK National Health Service since its inception made an…
Longitudinal continuity experiences can repair disconnects in the core clerkships for medical students.
Stevens, Carl D; Wilkerson, LuAnn; Uijtdehaage, Sebastian
The authors describe fundamental changes that have occurred in academic health centers since the 1990 s that have caused an increasingly fragmented experience during core clerkships where medical students risk disconnection from faculty mentors, residents, and patients. Longitudinal "continuity" clinical experiences may constitute a strategy for restoring some of the historic learning conditions. In this issue, Myhre and colleagues and Woloschuk and colleagues compare the performance of students who completed a longitudinal integrated clerkship with the performance of their peers who had completed a traditional rotation-based clerkship year and find that the results are comparable in medical school and after the first year of family medicine residency training. In addition, the authors of this commentary offer observations from their own experience with adding continuity options to traditional core clinical clerkships, with the goal of helping readers understand the range of opportunities and challenges that such initiatives entail. PMID:24362395
Recent Advances: Geriatric Medicine
Rebecca D Elon
Summary pointsExercise has protective effects: it is associated with decreased disability score and decreased rate of myocardial infarction; it is also effective in very old peopleMultifactorial interventions decrease the likelihood of fallsLow body mass considerably increases the risk of hip fracture in older women; other risk factors include alcohol consumption, prior stroke, low activity levels, use of long acting benzodiazepines,
Prejudices and elderly patients' personality – the problem of quality of care and quality of life in geriatric medicine
B?achnio, Aleksandra; Buli?ski, Leszek
Background The article discusses the position of elderly patients in the context of medical intervention. The phenomenon of a "greying" population has changed the attitude towards the elderly but common observations prove that the quality of geriatric care is still unsatisfactory. This is a comparative study of personality among people at different ages, designed to improve specialists' understanding of ageing. The results are discussed in relation to the elderly patient-centered paradigm to counterbalance ageist practices. Material/Methods This study involved 164 persons in early and late adulthood. Among the old, there were the young old (ages 65–74) and the older old (ages 75+). All participants were asked to fill-out the NEO-FFI [11]. Results The results demonstrate age-related differences in personality. In late adulthood, in comparison to early adulthood, there is decreased openness to new experiences. Two traits – agreeableness and conscientiousness – increase significantly. Age did not differentiate significantly the level of neuroticism or extraversion. The results of cluster analyses show differences in taxonomies of personality traits at different periods of life. Conclusions The results challenge the stereotypes that present older people as neurotic and aggressive. Age did not significantly influence the level of neuroticism or extraversion. In general, the obtained results prove that the ageist assumption that geriatric patients are troublesome is false. This article builds support for effective change in geriatric professional practices and improvement in elderly patients' quality of life. PMID:23949099
Colin A. Depp; Jody Corey-Bloom
At one time, the psychiatry of old age was believed to be "the darkest area of psychiatry." The often confounding nature of\\u000a psychiatric disorder in the elderly is illustrated by the large number of terms used over the years to address the diversity\\u000a among geriatric psychiatric patients, including "late paraphrenia," "vascular depression," "pseudodementia," and "masked depression."\\u000a Many of these labels
Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders 1? 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is\\/are associated. ? Key references
Randolph L Roig; Gregory M Worsowicz; Deborah G Stewart; David X Cifu
Roig RL, Worsowicz GM, Stewart DG, Cifu DX. Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders. Arch Phys Med Rehabil 2004;85(Suppl 3):S12–7.This self-directed learning module highlights physical medicine and rehabilitation (PM&R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education
Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center and a Community Health System
Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B
The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills. Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment. Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551
Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.
Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B
The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551
[Geriatric traumatology - vision or reality?].
Koudela, Karel; Kasal, E; Matejka, J; Vyskocil, V
The aim of the paper is to provide information on the establishment of the Geriatric Fracture Centre (GFC) at the Department of Orthopaedics and Traumatology, Faculty Hospital at the Faculty of Medicine, Charles University, Pilsner, whose goals and services are in accordance with the principles of the Rochester GFC, USA, and the AO Foundation at Synthes Inc. The paper presents up-to-date information on the methods of osteosynthesis for the skeletal system affected by osteoporosis, the majority of which was obtained in the AO Geriatric Fracture Course in Davos, December 2007. The authors are concerned with the pre-operative examination of geriatric patients who suffered a fracture.The anaesthesiologist's view on our elderly patients, their pre-operative preparation, anaesthesia application and post-operative care are presented.The novel method of two-phase bone densitometry and its role in the therapy of osteoporosis for elderly patients with fractures are also mentioned. PMID:19755061
An Interviewing Course for a Psychiatry Clerkship
ERIC Educational Resources Information Center
Nuzzarello, Angela; Birndorf, Catherine
Objective: Taking a psychiatric history is a key educational objective in the psychiatry clerkship. Medical students arrive on psychiatry clerkships unprepared for the unique challenges of psychiatric interviewing. This paper describes an interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group…
Construct validity and generalizability of pediatrics clerkship evaluation at a problem-based medical school, Bahrain.
Al-Mahroos, Fadheela
The aim of this study is to identify the sources of construct validity evidence and determine generalizability of the scores given to medical students on pediatrics clerkship evaluation at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU). The CMMS-AGU is a problem-based medical school in Bahrain. The sample was composed of 140 students. Validity evidence and generalizability theory were sought. Results indicated that pediatrics clerkship evaluation at CMMS-AGU has content validity. Some limitations may have occurred in response process, but the students performance was observed directly by the tutors. There was evidence of range restriction and "halo'' effect. Interrater reliability was 0.74, and the generalizability coefficient for three raters was 0.61. Students' contribution to the variance component of the global clerkship evaluation scores was 24%. Decision study indicated that seven tutors are required to achieve a generalizability coefficient of about 0.80. In conclusion, this study indicated that the pediatrics clerkship evaluation at the CMMS-AGU has, overall, some acceptable content and internal structure evidence of validity and that the raters are the major source of error. To improve the construct validity, there is a need to increase the number of raters and to train raters about the proper process of clerkship evaluation. PMID:19448161
Near-Peer Teaching in a Required Third-Year Clerkship
Meller, Stephanie M.; Chen, Michelle; Chen, Ruijun; Haeseler, Frederick D.
Students who teach less experienced students within the same educational program are known as near-peer teachers. A number of studies have shown that near-peers are effective teachers in preclinical courses such as anatomy and physical examination. We hypothesized that near-peers could also be effective teachers in a clinical clerkship. We report on a pilot study in which near-peers participated in a training session and then taught a brief problem-focused skills curriculum to third-year students during a required ambulatory medicine rotation. The clerkship students assigned high ratings to the near-peer teachers, both on an absolute scale and relative to faculty. The results suggest that including near-peers as teachers in a clinical clerkship may be appropriate and that this concept deserves further investigation. PMID:24348221
Standards for Psychiatry Clerkship Directors.
Kuhn, Thomas W.; Cohen, Mitchell J.M.; Polan, H. Jonathan; Campbell, E. Cabrina; Clegg, Kathleen A.; Brodkey, Amy C.
The authors review the literature relevant to the position of Psychiatry Clerkship Director (PCD) and propose standards regarding the expectations for this position. The standards address qualifications, duties, and competencies in the areas of leadership, administration, education, mentoring, and scholarship, as well as the resources of time, administrative assistance, budget, and compensation required to carry out these duties. This paper has been endorsed by the Council of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP), by the American Psychiatric Association's Committee on Medical Student Education, and by the Executive Committee of the American Association of Chairmen of Departments of Psychiatry. PMID:11867426
Progress in Geriatrics: A Clinical Care Update.
ERIC Educational Resources Information Center
Blanchette, Patricia Lanoie; And Others
This issue includes 18 theme articles that examine clinical care, conditions, and practice as they relate to older adults. It contains articles on the following: men's and women's health, depression, dementia, hypertension, incontinence, bone pain, infections, preventive medicine, geriatric medicine, health care delivery, managed care, long-term…
Georgia Geriatric Education Center
Arnold, Jonathan
Georgia Geriatric Education Center © Photography courtesy of the U.S. Administration on Aging minorities. Falls and Fall Prevention Causes of falls in older adults and interventions that could reduce or prevent falls. Geriatric Care Management Role, function and qualifications of Geriatric Care Managers
UConn Center on Aging Summer Geriatrics Conferences 28th
Kim, Duck O.
UConn Center on Aging Summer Geriatrics Conferences  28th Year UPDATE IN GERIATRIC MEDICINE Chief of Aging 10:15 Gail Sullivan, MD, MPH Approach to Older Adults 7/18 9:00 Leonard Oshinskie, OD Eye Problems Judge, MD Falls, Gait Problems, & Fall Prevention Rev 710/14 #12;Course Director Gail M. Sullivan, MD
University of Pennsylvania Geriatric Medicine Fellowship The School of Medicine ranks in the top five research institutions in the United States. Fellows
Bushman, Frederic
Introduction to quality measures and quality assessment Nursing Home policies and procedures Principles with education-based manuscripts Teaching is supported through continuing grants from the Health Resources-professional Collaborators: School of Nursing, Department of Family Medicine and Community Health, Department of Psychiatry
Ethical dilemmas in clerkship rotations.
Myers, Michael F; Herb, Alice
A sound clinical education should include the opportunity for medical students to engage in a spirited and informed discussion with faculty about the ethical challenges they will undoubtedly face. Unfortunately, in many medical schools today this goal is thwarted by many factors, including denial that a problem exists, relentless system overload, unprofessional behavior, breakdown in communication, and inertia. What is worse is that this problem is not new, and the fallout is not insignificant. Another potential contributing factor is burnout, which is well documented in a high percentage of medical students, residents, and faculty, and two of its most serious consequences are patient dissatisfaction and medical error.The authors draw on hundreds of student reflections on ethical dilemmas submitted during classroom exercises to examine persistent themes. They posit that classroom and didactic teaching is not enough to enable students to face ethical dilemmas. The authors call for a major culture change in medical education: "buy in" from top administration, especially the dean (and associate/assistant deans), chairs of all departments, and clerkship and residency training directors; the appointing of an ombudsperson and/or ethicist to oversee and resolve issues as they arise; instructional workshops and materials to enhance and impart skills for all teachers; remediation or retiring of errant faculty; and ongoing research and dialogue between and among medical centers about novel solutions. PMID:24072128
[What's new in geriatric medicine].
Eyer, Stephan; Rochat, Stéphane; Monod, Stéfanie; Büla, Christophe; Gold, Gabriel
Several studies clarified the role of different interventions such as vitamine D replacement, denosumab treatment, and vertebroplasty in the prevention and management of falls and fractures. A trial tested the effectiveness of pharmaceutical assistance at the time of discharge, emphasizing the potential benefits for the patients and the health care system. Syncopal episodes frequently lead to hospital admission. A retrospective study evaluated the diagnostic yield of different tests and emphasized the importance to actively seek orthostatic hypotension in older patients. Finally, advances remain modest in the field of dementias. PMID:20196429
Academic career development in geriatric fellowship training.
Medina-Walpole, Annette; Fonzi, Judith; Katz, Paul R
Career development is rarely formalized in the curricula of geriatric fellowship programs, and the training of new generations of academic leaders is challenging in the 1 year of fellowship training. To effectively prepare fellows for academic leadership, the University of Rochester's Division of Geriatrics, in collaboration with the Warner School of Graduate Education, created a yearlong course to achieve excellence in teaching and career development during the 1-year geriatric fellowship. Nine interdisciplinary geriatric medicine, dentistry, and psychiatry fellows completed the course in its initial year (2005/06). As participants, fellows gained the knowledge and experience to successfully develop and implement educational initiatives in various formats. Fellows acquired teaching and leadership skills necessary to succeed as clinician-educators in an academic setting and to communicate effectively with patients, families, and colleagues. Fellows completed a series of individual and group education projects, including academic portfolio development, curriculum vitae revision, abstract submission and poster presentation at national meetings, lay lecture series development, and geriatric grand rounds presentation. One hundred percent of fellows reported that the course positively affected their career development, with six of nine fellows choosing academic careers. The course provided opportunities to teach and assess all six of the Accreditation Council of Graduate Medical Education core competencies. This academic career development course was intended to prepare geriatric fellows as the next generation of academic leaders as clinician-teacher-scholars. It could set a new standard for academic development during fellowship training and provide a model for national dissemination in other geriatric and subspecialty fellowship programs. PMID:17971139
Biagioli, Frances E.; Rdesinski, Rebecca E.; Elliot, Diane L.; Chappelle, Kathryn G.; Kwong, Karen L.; Toffler, William L.
PURPOSE To determine whether a brief student survey can differentiate amongst third-year clerkship student's professionalism experiences and whether sharing specific feedback with surgery faculty and residents can lead to improvements. METHODS Medical students completed a survey on professionalism at the conclusion of each third-year clerkship specialty rotation during academic years 2007-2010. RESULTS 2007-2008 comparisons of survey items revealed significantly lower ratings for the surgery clerkship on both Excellence (F = 10.75, p < 0.001) and Altruism/Respect (F = 15.59, p < 0.001) subscales. This data was shared with clerkship directors, prompting the surgery department to discuss student perceptions of professionalism with faculty and residents. Post-meeting ratings of surgery professionalism significantly improved on both Excellence and Altruism/Respect dimensions (p < 0.005 for each). CONCLUSIONS A brief survey can be used to measure student perceptions of professionalism and an intervention as simple as a surgery department openly sharing results and communicating expectations appears to drive positive change in student experiences. COMPETENCIES Professionalism, Interpersonal and Communication Skills PMID:23337685
Medical Student Abuse During Clinical Clerkships in Japan
Nagata-Kobayashi, Shizuko; Sekimoto, Miho; Koyama, Hiroshi; Yamamoto, Wari; Goto, Eiji; Fukushima, Osamu; Ino, Teruo; Shimada, Tomoe; Shimbo, Takuro; Asai, Atsushi; Koizumi, Shunzo; Fukui, Tsuguya
OBJECTIVE To assess the prevalence of medical student abuse during clinical clerkships in Japan. DESIGN A cross-sectional questionnaire survey. SETTING Six medical schools in Japan. PARTICIPANTS Final year (sixth-year) and fifth-year medical students in the period from September 2003 to January 2004. From a total of 559 students solicited, 304 (54.4%) returned the questionnaire, and 276 (49.4%: 178 male and 98 female) completed it. MEASUREMENTS Prevalence of medical student abuse in 5 categories: verbal abuse, physical abuse, academic abuse, sexual harassment, and gender discrimination; differences in abusive experience between male and female students; types of alleged abusers; reporting abusive experiences to authorities; and emotional effects of abusive experiences. RESULTS Medical student abuse was reported by 68.5% of the respondents. Verbal abuse was the most frequently experienced abuse (male students 52.8%, female students 63.3%). Sexual harassment was experienced significantly more often (P<.001) by female students (54.1%) than by male students (14.6%). Faculty members were most often reported as abusers (45.2% of cases). Abuse occurred most frequently during surgical rotations (42.0% of cases), followed by internal medicine (25.1%) and anesthesia rotations (21.8%). Very few abused students reported their abusive experiences to authorities (8.5%). The most frequent emotional response to abuse was anger (27.1% of cases). CONCLUSIONS Although experience of abuse during clinical clerkships is common among medical students in Japan, the concept of "medical student abuse" is not yet familiar to Japanese. To improve the learning environment, medical educators need to take action to resolve this serious issue. PMID:16390504
Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study
Background In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a 'community of practice' with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages. Methods Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis. Results The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors' commitment to their profession, 'handing on' to the next generation and helping their community to attract doctors in the future. Conclusions Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution. PMID:21951836
An Approach to Address Grade Inflation in a Psychiatry Clerkship
ERIC Educational Resources Information Center
Roman, Brenda J. B.; Trevino, Justin
Objective: Universally, clerkship grading is diverse and not standardized. The authors' faculty was troubled by the inability to provide meaningful evaluations, as more than 60% of students received the highest grade. Although a psychiatry clerkship mandate of a faculty-observed student clinical interview existed for several years, the majority of…
[Drawn towards a career in elderly care medicine, but not till after medical school. Elderly care medicine as a career choice].
Meiboom, A A; de Vries, H; Hesselink, B A M; Hertogh, C M P M; Scheele, F
In order to develop strategies for raising the interest of medical students in a career in elderly care medicine (a specialty in The Netherlands) we should start by gaining more insight into the process influencing career choices among medical students and graduates. In this qualitative study we conducted three focus group discussions with trainees in elderly care medicine and two focus group discussions with obstetrics and gynaecology trainees. We found that all trainees made their career choice after clinical exposure in the field. The elderly care medicine trainees did not make their choice until after graduation, working in temporary employment in a nursing home. The obstetrics and gynaecology trainees made their specialty choice during medical school after their clerkship. Almost all focus group participants had a very negative perception during medical school about geriatrics and elderly care medicine. Once they were employed in a nursing home they changed their minds. They came to realize the work was more interesting, more difficult, more intensive and more meaningful than they had initially thought. PMID:24399288
Cognitive Screening in Geriatric Rehabilitation
Robert A. Ruchinskas; Kimberly J. Curyto
Objective: To aid rehabilitation psychologists' selection of brief measures of cognition for use in geriatric rehabilitation. Design: Literature review of neuropsychological screening measures that have been used and researched in geriatric rehabilitation, along with some newer instruments that have potential efficacy. Conclusions: All of the cognitive screening measures reviewed have varying degrees of strength and weakness in a geriatric rehabilitation
[History of the Czech gerontology and geriatrics].
Pacovský, V
Development of Czech gerontology and geriatrics can be associated with the Prague gerontology, namely with the First Faculty of Medicine (formally the Faculty of General Medicine). Prague school of gerontology was established. The decisive events related to the subject are described. Paper is based on the already published information on the history of the specialization and on the personal memorials of personal observers in the last fifty years. Reflections on the origin and establishment of a new medical specialization conclude the paper. PMID:17091735
Exposure and attitudes toward interprofessional teams: a three-year prospective study of longitudinal integrated clerkship versus rotation-based clerkship students.
Myhre, Douglas L; Woloschuk, Wayne; Pedersen, Jeanette Somlak
This study explored exposure to, and attitudes toward, interprofessional (IP) teams between third-year longitudinal integrated clerkship (LIC) and traditional rotation-based clerkship (RBC) students at the University of Calgary medical school. Students completed a survey pre-post 32-week LIC or 6-week rural, regional or urban RBC family medicine rotations. Pre and post rotation surveys were completed by 213 (48%) students (LIC?=?33/34; rural?=?76/152; regional?=?24/46; urban?=?80/208). More LIC students (76%) reported participating on six or more IP teams than RBC students (rural?=?38%; regional?=?25%; urban?=?21%). At pre rotation, the mean attitude to IP teams score of LIC and rural RBC students was high and did not differ. At post rotation, the mean attitude score of LIC students was significantly greater than the mean reported by rural RBC students. Only LIC students reported a significant pre-post rotation increase in attitude. Exposure to IP teams, possibly facilitated by a longer duration of rotation, appears to be an important factor in affecting attitude to IP teams. PMID:24000879
Clerkship maturity: Does the idea of training clinical skills work?
Stosch, Christoph; Joachim, Alexander; Ascher, Johannes
Background: With the reformed curriculum "4C", the Medical Faculty of the University of Cologne has started to systematically plan practical skills training, for which Clerkship Maturity is the first step. The key guidelines along which the curriculum was development were developed by experts. This approach has now been validated. Materials and methods: Both students and teachers were asked to fill in a questionnaire regarding preclinical practical skills training to confirm the concept of Clerkship Maturity. Results and discussion: The Cologne training program Clerkship Maturity can be validated empirically overall through the activities of the students awaiting the clerkship framework and through the evaluation by the medical staff providing the training. The subjective ratings of the advantages of the training by the students leave room for improvement. Apart from minor improvements to the program, the most likely solution providing sustainable results will involve an over-regional strategy for establishing skills training planned as part of the curriculum. PMID:21866243
A Model Intensive Course in Geriatric Teaching for Non-geriatrician Educators
Park, EunMi; Schmaltz, Heidi; Gozu, Aysegul; Durso, Samuel C.
Summary Introduction Because of the aging demographics nearly all medical specialties require faculty who are competent to teach geriatric care principles to learners, yet many non-geriatrician physician faculty members report they are not prepared for this role. Aims To determine the impact of a new educational intervention designed to improve the self-efficacy and ability of non-geriatrician clinician-educators to teach geriatric medicine principles to medical students and residents. Description Forty-two non-geriatrician clinician-educator faculty from17 academic centers self-selected to participate in a 3-day on-site interactive intensive course designed to increase knowledge of specific geriatric medicine principles and to enhance teaching efficacy followed by up to a year of mentorship by geriatrics faculty after participants return to their home institutions. On average, 24% of their faculty time was spent teaching and 57% of their clinical practices involved patients aged over 65 years. Half of all participants were in General Internal Medicine, and the remaining were from diverse areas of medicine. Evaluation Tests of geriatrics medical knowledge and attitudes were high at baseline and did not significantly change after the intervention. Self-rated knowledge about specific geriatric syndromes, self-efficacy to teach geriatrics, and reported value for learning about geriatrics all improved significantly after the intervention. A quarter of the participants reported they had achieved at least one of their self-selected 6-month teaching goals. Discussion An intensive 3-day on-site course was effective in improving self-reported knowledge, value, and confidence for teaching geriatrics principles but not in changing standardized tests of geriatrics knowledge and attitudes in a diverse group of clinician-educator faculty. This intervention was somewhat associated with new teaching behaviors 6 months after the intervention. Longer-term investigations are underway to determine the sustainability of the effect and to determine which factors predict the faculty who most benefit from this innovative model. PMID:18612742
Comprehensive geriatric assessment and traditional Chinese medicine intervention benefit symptom control in elderly patients with advanced non-small cell lung cancer.
Xue, Dong; Han, Shuyan; Jiang, Shantong; Sun, Hong; Chen, Yanzhi; Li, Yuanqing; Wang, Wei; Feng, Ye; Wang, Ke; Li, Pingping
The aim of this study was to observe the symptom improvement and clinical benefit in elderly patients with advanced non-small cell lung cancer (NSCLC) stratified on the basis of CGA findings after treatment with a combination of traditional Chinese medicine and Western medicine. Twenty-four elderly advanced NSCLC patients with a mean age of 73.0 ± 5.3 (65-83) years were categorized into three stratifications according to CGA results, namely function independent, mildly function impaired, and function dependent. They received standardized therapy, individualized therapy, and best supportive care, respectively. The patients receiving standardized therapy and individualized therapy were randomized into two groups, with or without traditional Chinese medicine for symptom control, while for all the patients receiving best supportive care, traditional Chinese medicine was administered. Nine non-elderly NSCLC patients (<65 years old) were enrolled as control and treated in accordance with NCCN NSCLC treatment guidelines. EORTC QLQ-C30 core scale, LC13 scale, and MDASI-TCM scale were used to assess relevant symptoms before and after treatment. After treatment for 3 weeks, it was shown by QLQ-C30+LC13 scales, for function-dependent patients, that the physical and role performances and the global health status were improved and the symptoms of fatigue and cough were alleviated; by MDASI-TCM scale, the symptoms of fatigue, cough, and expectoration were improved. In function-independent and mildly function-impaired elderly patients, there were no significant changes in functional status and symptoms. But in non-elderly patients, the physical and social performances were lowered, and the symptoms of fatigue, constipation, and poor appetite were aggravated. The elderly patients with advanced NSCLC were categorized on the basis of CGA findings, and traditional Chinese medicine may be beneficial to symptom control of function-dependent patients. PMID:25772512
Overview of geriatric nutrition
Jean Curran
Restoration and maintenance of optimal nutritional status in the long-term care setting may enhance the quality of life for\\u000a geriatric patients. The elderly are at increased risk for poor nutrition due to age-related physiological and psychosocial\\u000a changes, as well as the added toll of chronic disease. All of these may have a negative impact on adequate food intake. Health\\u000a care
Elizabeth A. Capezuti; Patricia Ursomanno; Marie Boltz; Hongsoo Kim
\\u000a Although patients aged 65 and over represent about 13% of the US population, they account for 40% of those undergoing surgical\\u000a procedures in American hospitals. Due to the increased likelihood of comorbidities, older patients also represent a higher\\u000a rate of postoperative complications that influence morbidity and mortality following major surgery. These problems have led\\u000a to the development of several geriatric
Do Geriatricians Stay in Geriatrics?
ERIC Educational Resources Information Center
Shah, Uday; Aung, Myo; Chan, Susanna; Wolfklein, Gisele
To evaluate whether formally trained geriatricians remain in the field of Geriatrics, and to determine their job satisfaction and perceived quality of life, we surveyed the 107 fellows trained over the last 25 years in one accredited geriatric program. Of the 88 physicians who consented to participate, 75% devoted at least half of their practice…
Teaching geriatric fellows how to teach: a needs assessment targeting geriatrics fellowship program directors.
Rivera, Veronica; Yukawa, Michi; Aronson, Louise; Widera, Eric
The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. PMID:25516033
Workplace learning through peer groups in medical school clerkships
Chou, Calvin L.; Teherani, Arianne; Masters, Dylan E.; Vener, Margo; Wamsley, Maria; Poncelet, Ann
Purpose When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups. Method We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences. Results In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills. Conclusions Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year. PMID:25427851
Geriatric Fever Score: A New Decision Rule for Geriatric Care
Vong, Si-Chon; Yang, Tzu-Meng; Chen, Kuo-Tai; Lin, Hung-Jung; Chen, Jiann-Hwa; Su, Shih-Bin; Guo, How-Ran; Hsu, Chien-Chin
Background Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups. Materials and Methods Consecutive geriatric patients (?65 years old) visiting the emergency department (ED) of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ?37.2°C or a baseline temperature elevated ?1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done. Results Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3), Severe coma (GCS ? 8), and Thrombocytopenia (platelets <150 103/mm3) (LST). After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0%) (95% CI: 2.3–6.9%): a general ward or treatment in the ED then discharge and high (30.3%) (95% CI: 17.4–47.3%): consider the intensive care unit. The area under the curve for the rule was 0.73. Conclusions We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need. PMID:25340811
Geriatric Nursing Teaching Resources
NSDL National Science Digital Library
Developed by the University of Minnesota's Hartford Center of Geriatric Nursing Excellence, these resources are designed to assist nursing students in their quest to become effective health care providers to older adults. After reading a brief introduction to the site, visitors can use the table of contents to find the materials that will be most useful to them. Here they will find a listing of over 40 topic areas, including Biology of Aging, Depression, and Oral Health. Most areas contain at least a dozen links, complete with brief descriptions of the resources and how they might be used in practice or in an educational setting. Finally, visitors can sign up to receive updates when new materials are posted to the site.
Teaching Programs in Geriatric Optometry.
ERIC Educational Resources Information Center
Rosenbloom, Albert A.
Results of a survey of U.S. and Canadian optometry programs concerning curriculum design, clinical and residency training programs, continuing education, and research projects planned or under way in geriatric optometry are presented and discussed. (MSE)
American Association for Geriatric Psychiatry
... psychiatry through special sessions, fellows, training directors, and leaders in the field. Donations received by September 30 ... APA awards the Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry and the Jack Weinberg Memorial ...
Geriatric conditions in heart failure
Dodson, John A.; Chaudhry, Sarwat I.
As the U.S. population ages, the prevalence of geriatric conditions in patients with heart failure is increasing, although they currently fall outside the traditional heart failure disease model. In this review, we describe the co-occurrence of four common geriatric conditions (cognitive impairment, frailty, falls, and incontinence) in older adults with heart failure, their mechanisms of interaction, and their association with outcomes. We propose a new paradigm to meet the needs of the aging heart failure population that includes comprehensive assessment of geriatric conditions and tailoring of therapy and surveillance accordingly. Coordination among relevant disciplines such as cardiology and geriatrics may facilitate this transition. Further research is needed in order to understand how to optimize care for patients with specific impairments in order to improve outcomes. PMID:23997843
Morimoto, S. Shizuko; Alexopoulos, George S.
Despite pioneering findings on immune functions in various depressive syndromes, few recent studies focus on the role of inflammation and its potential in generating novel antidepressant therapies. We suggest that geriatric depression is the behavioral syndrome par excellence in which inflammatory processes are likely to play an etiological role. We base this assertion on the following observations: Geriatric depression occurs in the context of medical and neurological illnesses in which inflammatory processes are part of their pathogenesis. Both aging and depression are associated with pronounced and prolonged immune responses. Brain areas related to mood processing, have increased inflammatory responses during aging. Moreover, the connectivity among mood regulating structures may be modulated by inflammatory responses. Geriatric depression exacerbates the pathology of its comorbid medical and neurological disorders raising the question whether depression-related inflammatory changes mediate the worsening of their outcomes. Finally, geriatric depression often occurs in persons exposed to chronic stress, a state precipitating geriatric depression and triggering pro-inflammatory responses. The clinical lesson derived from the available information is that depressed older adults should be examined for inflammatory disorders or risk factors of inflammation. It is premature to use anti-inflammatory agents in the treatment of geriatric depression. However, treatment of co-morbid conditions increasing CNS inflammatory responses can have general health benefits and should be part of clinical practice. Neuroimaging may identify microstructural abnormalities and dysfunction of neural networks associated with inflammatory processes accompanying geriatric depression. Transgenic animal models may help to identify candidate anti-inflammatory agents that later may be tested in clinical trials of geriatric depression. PMID:21536167
Perioperative Medicine and Pain Therapy Clerkship MID-ROTATION EVALUATION
Issa, Naoum
1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 Oral and Written Communication Professional Behavior OME NEW student demonstrated a proficiency in: Narrative Summary of Student's Performance Professionalism oximetry, capnography, blood pressure, continuous ECG) and discusses their limitations. 3. Clinically
Geisel School of Medicine Clerkship Change Request Form
Myers, Lawrence C.
. The location, Block number and dates are required. Calendars are available at: http://geiselmed.dartmouth.edu/admin/registrar/reg_course_info/2013-2014/ Block Number Start Date (mm/dd/yyyy) End Date (mm number and dates are required. Block Number Start Date (mm
Student Experiences with Competency Domains during a Psychiatry Clerkship
ERIC Educational Resources Information Center
West, Donald A.; Nierenberg, David W.
Objectives: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and…
Medical Students' Interest in Child Psychiatry: A Clerkship Intervention
ERIC Educational Resources Information Center
Martin, Vicki L.; Bennett, David S.; Pitale, Maria
Objective: The authors examine the efficacy of a brief presentation to enhance clerkship student interest in child and adolescent psychiatry as a career choice. Method: Attitudes of students attending a brief presentation on the positive aspects of child psychiatry were compared with those of non-attenders. Results: Students who attended the…
Increasing Interest in Child and Adolescent Psychiatry in the Third-Year Clerkship: Results from a Post-Clerkship Survey
ERIC Educational Resources Information Center
Malloy, Erin; Hollar, David; Lindsey, Anthony
Objective: The authors aimed to determine whether a structured clinical experience in child and adolescent psychiatry (CAP) during the third-year psychiatry clerkship would impact interest in pursuing careers in psychiatry and CAP. Methods: The authors constructed and administered a post-rotation survey, the Child and Adolescent Psychiatry…
A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency
Jagadeesan, Vikrant S. [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States); Raleigh, David R. [Department of Radiation Oncology, School of Medicine, University of California–San Francisco, San Francisco, California (United States); Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J. [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States); Golden, Daniel W., E-mail: firstname.lastname@example.com [Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois (United States)
Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ? P=.48) or confidence to function as a first year resident (Spearman ? P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results support further development of structured didactic curricula for the radiation oncology clerkship.
Teaching Geriatrics Away from the Medical Model.
ERIC Educational Resources Information Center
Stotts, Michael L.
Suggests alternatives to the medical education model for teaching geriatrics. Proposes geriatric learning that shows interdisciplinary care, stresses wellness over illness, and demonstrates examples of care, support, independence, and limited maintenance away from nursing homes and hospitals. (Author/ABB)
Models of Care in Geriatric Oncology
Magnuson, A.; Dale, W.; Mohile, S.
Cancer is common in older adults and the approach to cancer treatment and supportive measures in this age group is continuously evolving. Incorporating geriatric assessment (GA) into the care of the older patient with cancer has been shown to be feasible and predictive of outcomes, and there are unique aspects of the traditional geriatric domains that can be considered in this population. Geriatric assessment-guided interventions can also be developed to support patients during their treatment course. There are several existing models of incorporating geriatrics into oncology care, including a consultative geriatric assessment, geriatrician "embedded" within an oncology clinic and primary management by a dual-trained geriatric oncologist. Although a geriatrician or geriatric oncologist leads the geriatric assessment, is it truly a multidisciplinary assessment, and often includes evaluation by a physical therapist, occupational therapist, pharmacist, social worker and nutritionist. PMID:25587518
An Innovative Method for Teaching Epidemiology, Public Health, and Preventive Medicine.
ERIC Educational Resources Information Center
Duerson, Margaret C.; And Others
The Department of Community Health and Family Medicine at the University of Florida College of Medicine developed a curriculum component integrating epidemiologic concepts into a third year family medicine clerkship through a small-group project on a specific condition likely to be encountered by primary care physicians in community practice. (MSE)
Homocysteine and Cognitive Function in Geriatric Depression
P. Alexopoulos; S. Topalidis; G. Irmisch; K. Prehn; S. U. Jung; K. Poppe; H. Sebb; R. Perneczky; A. Kurz; S. Bleich; S. C. Herpertz
Background\\/Objectives: Cognitive dysfunction is a common aspect of the spectrum of symptoms of geriatric depression. High homocysteine levels have been linked to cognitive decline in neuropsychiatric disorders. The present study investigated possible associations between cognitive impairment observed in geriatric depression and homocysteine levels. Methods: The performance of 25 mentally healthy individuals and 40 patients with geriatric depression in terms of
Geriatric Dentistry in the Predoctoral Curriculum.
ERIC Educational Resources Information Center
Moshman, Jack; And Others
A survey of U.S. dental schools to determine the status of geriatric dentistry in the curriculum is discussed. Evidence of growing commitment is shown by deans who plan to give geriatric dentistry increasing priority in the future and by the fact that all schools now teach geriatric dentistry in some way. (MLW)
Gunning, Faith M.; Smith, Gwenn S.
Synopsis Abnormalities in specific cerebral networks likely confer vulnerability that increases the susceptibility for development of geriatric depression and impact the course of symptoms. Functional neuroimaging enables the in vivo identification of alterations in cerebral function that not only characterize disease vulnerability, but also may contribute to variability in depressive symptoms and antidepressant response. Judicious use of functional neuroimaging tools can advance pathophysiological models of geriatric depression. Furthermore, due to the age-related vulnerability of specific brain systems that have been implicated in mood disorders, geriatric depression provides a logical context within which to study the role of specific functional abnormalities in both antidepressant response and key behavioral and cognitive abnormalities of mood disorders. PMID:21536165
Geriatric Optometry Programs of Promise.
ERIC Educational Resources Information Center
Verma, Satya B.
The curriculum design, philosophy, and innovation of four programs in geriatric optometry are described: the Pennsylvania College of Optometry and the colleges of Optometry at the State University of New York, University of Alabama at Birmingham, and University of Houston. (MSE)
Training in Geriatric Mental Health
Burton V. Reifler
The author briefly reviews previous research on educational programs which have been effective in improving students' attitudes toward mentally ill elderly, then describes two model outpatient programs which have been successfully used as training sites. Geriatric and Family Services is a University based, family oriented clinic specializing in the diagnosis and management of Alzheimer's Disease. The other program described in
Screening Tests for Geriatric Depression
T. L. Brink; Jerome A. Yesavage; Owen Lum; Philip H. Heersema; Michael Adey; Terrence L. Rose
Contends that the diagnosis of depression in aged patients is the responsibility of both psychologists, and non-psychologists, for it is the latter that is most likely to make initial contact with an elder in need of help. Describes problems in the use of psychometric tests to identify geriatric depression. Reviews the advantages and disadvantages and limitations of scales currently employed.
Geriatrics in Lebanon: The Beginning.
ERIC Educational Resources Information Center
Abyad, A.
Discusses the roles of Lebanese health care systems and the American University of Beirut. Notes that morbidity burdens of geriatric populations can overwhelm health infrastructures already unable to meet prevention and treatment needs of a younger population with relatively low-cost, easy-to-prevent, easy-to-treat illnesses. Expresses Lebanon's…
Rhinitis in the geriatric population
Jayant M Pinto; Seema Jeswani
The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 20301. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people
Psychiatric OSCE Performance of Students with and without a Previous Core Psychiatry Clerkship
ERIC Educational Resources Information Center
Goisman, Robert M.; Levin, Robert M.; Krupat, Edward; Pelletier, Stephen R.; Alpert, Jonathan E.
Objective: The OSCE has been demonstrated to be a reliable and valid method by which to assess students' clinical skills. An OSCE station was used to determine whether or not students who had completed a core psychiatry clerkship demonstrated skills that were superior to those who had not taken the clerkship and which areas discriminated between…
Factors Determining Students' Global Satisfaction with Clerkships: An Analysis of a Two Year Students' Ratings Database
ERIC Educational Resources Information Center
Durak, Halil Ibrahim; Vatansever, Kevser; van Dalen, Jan; van der Vleuten, Cees
Clerkships would benefit from teachers' improved understanding of the didactic aspects of their task. The purpose of this study is to identify factors that determine the teaching quality of clerkships and to examine the predictive value of these factors for students' global satisfaction. Thus, results would be further reflected to clinical…
Effect of Curriculum Change on Exam Performance in a 4-Week Psychiatry Clerkship
ERIC Educational Resources Information Center
Niedermier, Julie; Way, David; Kasick, David; Kuperschmidt, Rada
Objective: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. Methods: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject…
Shorter Psychiatry Clerkship Length Is Associated with Lower NBME Psychiatry Shelf Exam Performance
ERIC Educational Resources Information Center
Bostwick, J. Michael; Alexander, Cara
Objective: The goal of this study was to evaluate a recent medical school curriculum change at our institution 3 years ago; specifically: shortening the Psychiatry core clerkship from 4 to 3 weeks and adding an optional 6-week core/elective combination rotation in lieu of the 3-week core. The authors aimed to determine whether clerkship length was…
Developing an exportable computer?based curriculum for a decentralized clerkship
Barbara G. Ferrell; Barbara L. Thompson
To provide all students in a decentralized clerkship with a similar educational experience, we used the computer's capability to integrate data needed for clerkship monitoring and its potential to deliver core curricular materials. An "exportable"; Learning Resource Center was developed to provide the necessary learning resources to students regardless of their training site. The Learning Resource Center comprises reference sources
Creating Stories to Live By: Caring and Professional Identity Formation in a Longitudinal Integrated Clerkship
ERIC Educational Resources Information Center
Konkin, Jill; Suddards, Carol
Building on other models of longitudinal integrated clerkships (LIC), the University of Alberta developed its Integrated Community Clerkship with guiding principles of continuity of care, preceptor and learning environment. Professionalism is an important theme in medical education. Caring is important in professional identity formation and an…
Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes?
Craig, LaTasha B.; Smith, Chad; Crow, Sheila M.; Driver, Whitney; Wallace, Michelle; Thompson, Britta M.
Objective To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. Study Design Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students' baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. Results Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, ? 2=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, ? 2=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. Conclusion Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored. PMID:24300748
Geriatric emergency department innovations: preliminary data for the geriatric nurse liaison model.
Aldeen, Amer Z; Courtney, D Mark; Lindquist, Lee A; Dresden, Scott M; Gravenor, Stephanie J
Older adults account for a large and growing segment of the emergency department (ED) population. They are often admitted to the hospital for nonurgent conditions such as dementia, impaired functional status, and gait instability. The aims of this geriatric ED innovations (GEDI) project were to develop GEDI nurse liaisons by training ED nurses in geriatric assessment and care coordination skills, describe characteristics of patients that these GEDI nurse liaisons see, and measure the admission rate of these patients. Four ED nurses participated in the GEDI training program, which consisted of 82 hours of clinical rotations in geriatrics and palliative medicine, 82 hours of didactics, and a pilot phase for refinement of the GEDI consultation process. Individuals were eligible for GEDI consultation if they had an Identification of Seniors At Risk (ISAR) score greater than 2 or at ED clinician request. GEDI consultation was available Monday through Friday from 9:00 a.m. to 8:00 p.m. An extensive database was set up to collect clinical outcomes data for all older adults in the ED before and after GEDI implementation. The liaisons underwent training from January through March 2013. From April through August 2013, 408 GEDI consultations were performed in 7,213 total older adults in the ED (5.7%, 95% confidence interval (CI) = 5.2-6.2%), 2,124 of whom were eligible for GEDI consultation (19.2%, 95% CI = 17.6-20.9%); 34.6% (95% CI = 30.1-39.3%) received social work consultation, 43.9% (95% CI = 39.1-48.7) received pharmacy consultation, and more than 90% received telephone follow-up. The admission rate for GEDI patients was 44.9% (95% CI = 40.1-49.7), compared with 60.0% (95% CI = 58.8-61.2) non-GEDI. ED nurses undergoing a 3-month training program can develop geriatric-specific assessment skills. Implementation of these skills in the ED may be associated with fewer admissions of older adults. PMID:25112656
Comprehensive geriatric assessment in the emergency department
Ellis, Graham; Marshall, Trudi; Ritchie, Claire
Changing global demography is resulting in older people presenting to emergency departments (EDs) in greater numbers than ever before. They present with greater urgency and are more likely to be admitted to hospital or re-attend and utilize greater resources. They experience longer waits for care and are less likely to be satisfied with their experiences. Not only that, but older people suffer poorer health outcomes after ED attendance, with higher mortality rates and greater dependence in activities of daily living or rates of admission to nursing homes. Older people's assessment and management in the ED can be complex, time consuming, and require specialist skills. The interplay of multiple comorbidities and functional decline result in the complex state of frailty that can predispose to poor health outcomes and greater care needs. Older people with frailty may present to services in an atypical fashion requiring detailed, multidimensional, and increasingly multidisciplinary care to provide the correct diagnosis and management as well as appropriate placement for ongoing care or admission avoidance. Specific challenges such as delirium, functional decline, or carer strain need to be screened for and managed appropriately. Identifying patients with specific frailty syndromes can be critical to identifying those at highest risk of poor outcomes and most likely to benefit from further specialist interventions. Models of care are evolving that aim to deliver multidimensional assessment and management by multidisciplinary specialist care teams (comprehensive geriatric assessment). Increasingly, these models are demonstrating improved outcomes, including admission avoidance or reduced death and dependence. Delivering this in the ED is an evolving area of practice that adapts the principles of geriatric medicine for the urgent-care environment. PMID:25473275
State of the Art in Geriatric Rehabilitation. Part I: Review of Frailty and Comprehensive Geriatric Assessment
Jennie L. Wells; Jamie A. Seabrook; Paul Stolee; Michael J. Borrie; Frank Knoefel
Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part I: Review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehabil 2003;84:890-7. Objectives: To increase recognition of geriatric rehabilita- tion and to provide recommendations for practice and future research. Data Sources: A CINAHL and 2 MEDLINE searches were conducted for 1980
Effects of a Geriatrics Interdisciplinary Experience on Learners' Knowledge and Attitudes
ERIC Educational Resources Information Center
Fitzgerald, James T.; Williams, Brent C.; Halter, Jeffrey B.; Remington, Tami L.; Foulk, Mariko A.; Persky, Neal W.; Shay, Barbara R.
This study examines the impact of an interdisciplinary training program on knowledge and attitudes of learners from four health care programs: medicine, pharmacy, social work, and nursing. Sixty-two learners participated in a 4-day educational program (one day each week for 4 weeks) focusing on interdisciplinary geriatric care. After completing…
Research advances in geriatric depression
Technical advances have facilitated the exploration of factors related to geriatric depression and have helped generate novel biological and psychosocial treatment approaches. This review summarizes the main advancements in epidemiology, clinical presentation and course, genetics, and other areas of biological research. Treatment interventions outlined in this paper include electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulatn, depression prophylaxis, multidisciplinary approaches to depression treatment, and psychotherapy. Forms of psychotherapy for geriatric depression summarized include interpersonal psychotherapy, supportive psychotherapy, cognitive-behavioral therapy, problem-solving therapy, and ecosystem-focused therapy. Neuroimaging techniques based on magnetic resonance imaging are discussed briefly, including volumetric brain studies, diffusion tensor imaging, fractional anisotropy, fiber tractography, magnetization transfer imaging, and blood-oxygenation-level-dependent functional magnetic resonance imaging. Finally, treatment effectiveness is addressed in a discussion of new models to improve access to and quality of care offered in the community. PMID:19812743
Rhinitis in the geriatric population
The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 2030[1]. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population. PMID:20465792
28 CFR 2.78 - Geriatric parole.
Code of Federal Regulations, 2014 CFR
...Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS, YOUTH OFFENDERS, AND JUVENILE DELINQUENTS District of Columbia Code: Prisoners and Parolees § 2.78 Geriatric parole....
28 CFR 2.78 - Geriatric parole.
Code of Federal Regulations, 2010 CFR
...Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS, YOUTH OFFENDERS, AND JUVENILE DELINQUENTS District of Columbia Code: Prisoners and Parolees § 2.78 Geriatric parole....
28 CFR 2.78 - Geriatric parole.
Code of Federal Regulations, 2011 CFR
...Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS, YOUTH OFFENDERS, AND JUVENILE DELINQUENTS District of Columbia Code: Prisoners and Parolees § 2.78 Geriatric parole....
28 CFR 2.78 - Geriatric parole.
Code of Federal Regulations, 2013 CFR
...Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS, YOUTH OFFENDERS, AND JUVENILE DELINQUENTS District of Columbia Code: Prisoners and Parolees § 2.78 Geriatric parole....
28 CFR 2.78 - Geriatric parole.
Code of Federal Regulations, 2012 CFR
...Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS, YOUTH OFFENDERS, AND JUVENILE DELINQUENTS District of Columbia Code: Prisoners and Parolees § 2.78 Geriatric parole....
Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes toward Homeless Persons
ERIC Educational Resources Information Center
Morrison, Ann; Roman, Brenda; Borges, Nicole
Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…
Integration of Women's Health into an Internal Medicine Core Curriculum for Medical Students.
ERIC Educational Resources Information Center
Nicolette, JoDean; Jacobs, Michael D.
Describes a collaboration to analyze and integrate elements of women's health into the core curriculum in internal medicine for a medical school's third year clerkship. Illustrates the new curriculum by describing the new module in pulmonary medicine and discusses the use of the process to integrate curricula in other interdisciplinary fields.…
Geriatrician Clinician-Educator The Division of Hospital Medicine and Division of General Internal Medicine &
Chapman, Michael S.
Geriatrician Clinician-Educator The Division of Hospital Medicine and Division of General Internal Medicine & Geriatrics within the Department of Medicine at Oregon Health & Science University seek to an academic career. This position will be a joint appointment in the Divisions of Hospital Medicine
Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care
Owusu, Cynthia; Berger, Nathan A
Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population – their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications – has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer. PMID:25642321
Workforce development in geriatric home care.
Hayashi, Jennifer; DeCherrie, Linda; Ratner, Edward; Boling, Peter A
With the rapidly aging population, it is anticipated that within two decades several million more individuals in the United States with functional impairment and serious ill health will need home health care. This article discusses workforce development, which is a critical issue for future planning, as recently highlighted by the Institute of Medicine (IOM). Key aspects of recruitment, training, and retention of home care workers are discussed, including those who provide basic support for activities of daily living as well as a variety of skilled professionals: therapists, nurses, pharmacists, and physicians. Although the geriatric workforce shortage affects all care settings, it is especially critical in home health care, in part because we are starting with far too few clinicians to meet the medical needs of homebound elderly. A combination of actions is needed, including educational programs, such as those developed by the American Academy of Home Care Physicians (AAHCP), changes in financial incentives, and changes in the culture and practice of health care, to make the home the primary focus of care for these vulnerable, underserved individuals rather than an afterthought. PMID:19217496
OPHTHALMOLOGY Course name and number: Clinical Ophthalmology: Clinical Clerkship: OPHTH420a .
OPHTHALMOLOGY Course name and number: Clinical Ophthalmology: Clinical Clerkship: OPHTH420a . Coordinator: Gale Abbass, Ophthalmology Education Coordinator, email@example.com Faculty: Yen Ngo, MD (Course Availability: All blocks (Best for aspiring ophthalmologists to take this early because Ophthalmology
Cognitive status and ambulation in geriatric rehabilitation: Walking without thinking?
Robert A. Ruchinskas; Hedy K. Singer; Nancy K. Repetz
Ruchinskas RA, Singer HK, Repetz NK. Cognitive status and ambulation in geriatric rehabilitation: walking without thinking? Arch Phys Med Rehabil 2000;81:1224-8. Objective: To assess the relation between cognitive and ambulatory abilities in geriatric rehabilitation inpatients. Study Design: Survey study of geriatric cohorts. Setting: Inpatient university hospital rehabilitation unit. Patients: One hundred fifty urban geriatric rehabilitation patients with orthopedic, neurologic, or
Videoteleconferencing for administration of a multisite obstetrics and gynecology core clerkship.
Browne, M W; Hines, J F; Satin, A J; Haffner, W H
Recent changes and trends in health care delivery have required medical schools to use multiple sites to obtain adequate patient exposure for their students. Decentralization of clinical undergraduate medical education may lead to a lack of continuity in curricula, evaluation, and feedback. We describe the use of interactive videoteleconferencing as a tool to link and improve a multi-site undergraduate core clerkship in obstetrics and gynecology. The Uniformed Services University of the Health Sciences, Bethesda, Maryland, currently utilizes five geographically separate sites for its 6-week core clerkship in obstetrics and gynecology. The site coordinators, clerkship director, and administrative personnel from the parent institution meet approximately 3 weeks after the completion of each core clerkship for live, real-time, and interactive broadcast to complete student evaluations, review curricula, and discuss problems with current students and other pertinent educational issues. Videoteleconferencing provides a mechanism to ensure consistency in curriculum and student evaluations and provides administrative support to distant sites. Furthermore, it enables site coordinators to keep the clerkship director abreast of students and clerkship issues. PMID:10711564
Writing tasks performed by doctor of pharmacy students during clerkship rotations.
Hobson, Eric H; Waite, Nancy M; Briceland, Laurie L
The range of writing tasks undertaken by students during doctor of pharmacy clerkship rotations was studied. Data collection involved a review between August and November 1998 of writing samples selected by postbaccalaureate Pharm. D. students at Albany College of Pharmacy for inclusion in their required writing portfolios. The first 200 samples (accounted for by 35 students each submitting two documents for each of three clerkship rotations) were reviewed. Of these, 198 were coded to identify the four rhetorical components of clerkship location, document type, intended audience, and rhetorical purpose. Institutional sites served as the clerkship location for 164 (82.8%) of the 198 documents analyzed. The documents were placed in 28 categories; 5 of these accounted for 126 (63.6%) of the documents: 45 inservice presentations, 32 summaries, 18 patient case write-ups, 16 formulary reviews, and 15 newsletters. Students wrote most frequently to health care providers (34.8%), other pharmacists (32.3%), and teachers (16.7%), with the most frequent rhetorical purposes being informing (73.2%) and demonstrating (14.6%). Analysis of writing samples prepared by pharmacy students during clerkship rotations revealed a variety of clerkship sites, document types, audiences, and rhetorical purposes. PMID:11813468
Comprehensive geriatric assessment in oncology.
Mohile, Supriya G; Magnuson, Allison
The incidence of cancer increases with advanced age and the majority of cancer deaths are in patients aged ? 65. The geriatric population is a heterogeneous group and a patient's chronologic age does not always correlate with underlying physiologic status. Oncologists need to be able to obtain information on physiologic and functional capacity in older patients in order to provide safe and effective treatment recommendations. The Comprehensive Geriatric Assessment (CGA) is a compilation of validated tools that predict morbidity and mortality in community-dwelling older adults. The various components of the CGA have also been shown to influence clinical decision-making and predict outcomes in older cancer patients. The combined data from the CGA can be used to stratify patients into risk categories to better predict their tolerance to treatment and risk for chemotherapy toxicity. However, the CGA is a comprehensive tool requiring significant time and training to perform. A variety of screening tools have been developed which may be useful in the general oncology practice setting to identify patients that may benefit from further testing and intervention. This chapter will review the components and predictive value of CGA in older cancer patients, with emphasis on how CGA can practically be incorporated into clinical practice. PMID:23503518
Terror Medicine as Part of the Medical School Curriculum
Cole, Leonard A.; Wagner, Katherine; Scott, Sandra; Connell, Nancy D.; Cooper, Arthur; Kennedy, Cheryl Ann; Natal, Brenda; Lamba, Sangeeta
Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training. PMID:25309891
Medical student abuse during clinical clerkships in Japan
Shizuko Nagata-Kobayashi; Miho Sekimoto; Hiroshi Koyama; Wari Yamamoto; Eiji Goto; Osamu Fukushima; Teruo Ino; Tomoe Shimada; Takuro Shimbo; Atsushi Asai; Shunzo Koizumi; Tsuguya Fukui
OBJECTIVE: To assess the prevalence of medical student abuse during clinical clerkships in Japan.\\u000a \\u000a \\u000a DESIGN: A cross-sectional questionnaire survey.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Six medical schools in Japan.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Final year (sixth-year) and fifth-year medical students in the period from September 2003 to January 2004. From a total of\\u000a 559 students solicited, 304 (54.4%) returned the questionnaire, and 276 (49.4%: 178 male and
Büla, Christophe
This overview covers several topics related to the management of frequent problems in elderly persons. Several studies have shown that treatment of neuropsychiatric symptoms of dementia with psychotropic medication is modestly effective and could increase the risk of adverse events, including death. Influenza vaccination in long term care residents was shown to be effective in a systematic review, while post-exposure prophylaxis with oseltamivir, a neuraminidase inhibitor, seems cost-effective in vaccinated residents during an epidemics in a nursing home. Conflicting results were observed in studies of fracture prevention with vitamine D. Finally, one study showed the potential pifalls of guidelines developed for specific chronic medical conditions when applied simultaneously to older patients with complex comorbidities. PMID:16465940
The Merck Manual of Geriatrics
NSDL National Science Digital Library
Merck and Co., Inc., publisher of the standard medical text The Merck Manual of Diagnosis and Therapy (described in the July 19, 1996 Scout Report but no longer available in an Internet version), has placed online the full text of another of its publications, The Merck Manual of Geriatrics. The Manual focuses on the medical problems and care of the elderly and is directed at healthcare professionals, but many older users and those caring for elderly relatives may find it useful. Divided into five sections and 114 chapters, the Manual offers a comprehensive review of the medical, social, psychological, and ethical issues involved in elder healthcare. Sample topics include nutrition, sleep disorders, pharmacology, organ system disorders, sexuality, psychiatric disorders, legal issues, and health insurance, among many others. The entire publication is searchable, and a guide for readers of the online version is provided.
The Merck Manual of Geriatrics
NSDL National Science Digital Library
Merck and Co., Inc., publisher of the standard medical text The Merck Manual of Diagnosis and Therapy (described in the July 19, 1996 Scout Report but no longer available in an Internet version), has placed online the full text of another of its publications, The Merck Manual of Geriatrics. The Manual focuses on the medical problems and care of the elderly and is directed at healthcare professionals, but many older users and those caring for elderly relatives may find it useful. Divided into five sections and 114 chapters, the Manual offers a comprehensive review of the medical, social, psychological, and ethical issues involved in elder healthcare. Sample topics include nutrition, sleep disorders, pharmacology, organ system disorders, sexuality, psychiatric disorders, legal issues, and health insurance, among many others. The entire publication is searchable, and a guide for readers of the online version is provided.
Hypernatremia in the geriatric population
Shah, Maulin K; Workeneh, Biruh; Taffet, George E
Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. Older people are predisposed to developing hypernatremia because of age-related physiologic changes such as decreased thirst drive, impaired urinary concentrating ability, and reduced total body water. Medications may exacerbate this predisposition. Hypernatremia and dehydration occurring in nursing homes are considered indicators of neglect that warrant reporting, but there are other nonavoidable causes of hypernatremia, and consideration at time of presentation is essential to prevent delay in diagnosis and management. We describe a case illustrating the importance of the consideration of alternate explanations for hypernatremia in a nursing home resident, followed by a review of hypernatremia in the elderly population, to underscore that neglect is the etiology of exclusion after alternatives have been considered. PMID:25429210
Toenail Onychomycosis in a Portuguese Geriatric Population
N. Dias; C. Santos; M. Portela; N. Lima
Onychomycosis is a common fungal infection of the nail but few data of mycological features in geriatric Portuguese population\\u000a are yet available. The aim of this study was to perform a mycological examination and characterization of fungal nail pattern\\u000a of a geriatric population from the north of Portugal clinically suspected of onychomycosis. A total of 108 patients attending\\u000a the Podology
The Clinical Education of Medical Students: A Perspective from Internal Medicine.
ERIC Educational Resources Information Center
Tierney, Lawrence M., Jr.
A summary of what is generally thought to be taught well in internal medicine and what is taught less effectively is presented. The roles of medical students are considered in that context. Teaching contributions, evaluation of teaching, problems on clerkships, and opportunities for change are discussed. (MLW)
Advancing geriatrics research, education, and practice: policy challenges after the great recession.
Zerzan, Judy T; Rich, Eugene C
The series of articles in this JGIM issue provides a number of policy-relevant recommendations for advancing geriatrics research, education and practice. Despite the unprecedented pressure to reduce state and federal spending, policymakers must concurrently address the challenges of a growing population of older individuals with increasingly complex health care problems. Thus, there may be opportunities to advance this agenda in creative ways. For example, without new spending, federal research agencies can make changes to encourage needed new directions in aging research, and the ACA provides new funding opportunities such as the Patient Centered Outcomes Research Institute. States and the federal government have an increasing need for the health professions workforce to have collaborative care skills and geriatrics clinical competencies, and are finding ways to invest in relevant initiatives. On the clinical program side, state and federal governments are initiating programs to promote delivery system changes that improve the care of older adults. Nonetheless, in the face of the policy challenges that have persisted after the "great recession," academic geriatrics and general internal medicine will need to join forces with public and private interests to secure the resources needed to advance this ambitious agenda for geriatrics research, education and practice. PMID:24557514
[Imaging update in geriatric oncology].
Gualdi, G F; Bertini, L; Lanciotti, S; Colaiacomo, M C; Casciani, E; Polettini, E
The cancer is a problem that plagues all the ages but the greater part of the malignant tumors hits the old persons. The more elevated incidence sites of primary tumor in geriatrical age are the prostate, the lung and the colon-rectum in the men and the breast, the colon-rectum, the lung and the stomach in the women. The imaging has made steps of giant in the last few decades, with the introduction of new equipment and methodical news so as to assure everybody early and accurated diagnosis. For the lung carcinoma great advantages have been bring to us with the introduction of CT-PET and the multislice CT, that has concurred the execution of virtual bronchoscopy. The virtual endoscopy has been applied with happening also in the screening of the carcinoma of colon-rectum, executed through CT or MR. New MR technologies have allowed perform spectroscopic studies in such organs as prostate and breast, bringing the biochemical diagnosis beyond that morphologic. The MR then turns out fundamental in the appraisal of the Patient with bone metastases thanks also to the new whole body examinations. Finally the recent technology has allowed the execution of multiorgan CT screening bringing in this way new possibilities but also new questions. PMID:15700630
Visiting medical student elective and clerkship programs: a survey of US and Puerto Rico allopathic medical schools
Background No published reports of studies have provided aggregate data on visiting medical student (VMS) programs at allopathic medical schools. Methods During 2006, a paper survey was mailed to all 129 allopathic medical schools in the United States and Puerto Rico using a list obtained from the Association of American Medical Colleges. Contents of the survey items were based on existing literature and expert opinion and addressed various topics related to VMS programs, including organizational aspects, program objectives, and practical issues. Responses to the survey items were yes-or-no, multiple-choice, fill-in-the-blank, and free-text responses. Data related to the survey responses were summarized using descriptive statistics. Results Representatives of 76 schools (59%) responded to the survey. Of these, 73 (96%) reported their schools had VMS programs. The most common reason for having a VMS program was "recruitment for residency programs" (90%). "Desire to do a residency at our institution" was ranked as the leading reason visiting medical students choose to do electives or clerkships. In descending order, the most popular rotations were in internal medicine, orthopedic surgery, emergency medicine, and pediatrics. All VMS programs allowed fourth-year medical students, and approximately half (58%) allowed international medical students. The most common eligibility requirements were documentation of immunizations (92%), previous clinical experience (85%), and successful completion of United States Medical Licensing Examination Step 1 (51%). Of the programs that required clinical experience, 82% required 33 weeks or more. Most institutions (96%) gave priority for electives and clerkships to their own students over visiting students, and a majority (78%) reported that visiting students were evaluated no differently than their own students. During academic year 2006-2007, the number of new resident physicians who were former visiting medical students ranged widely among the responding institutions (range, 0-76). Conclusions Medical schools' leading reason for having VMS programs is recruitment into residency programs and the most commonly cited reason students participate in these programs is to secure residency positions. However, further research is needed regarding factors that determine the effectiveness of VMS programs in residency program recruitment and the development of more universal standards for VMS eligibility requirements and assessment. PMID:20529301
Twelve tips for designing and running longitudinal integrated clerkships.
Ellaway, Rachel; Graves, Lisa; Berry, Sue; Myhre, Doug; Cummings, Beth-Ann; Konkin, Jill
Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs. PMID:23883396
Time to trust: longitudinal integrated clerkships and entrustable professional activities.
Hirsh, David A; Holmboe, Eric S; ten Cate, Olle
Medical education shaped by the learning sciences can better serve medical students, residents, faculty, health care institutions, and patients. With increasing innovation in undergraduate and graduate medical education and more focused attention on educational principles and how people learn, this era of educational transformation offers promise. Principles manifest in "educational continuity" are informing changes in educational structures and venues and are enriching new discourse in educational pedagogy, assessment, and scholarship. The articles by Myhre and colleagues and Woloschuk and colleagues in this issue, along with mounting evidence preceding these works, should reassure that principle-driven innovation in medical education is not only possible but can be achieved safely. In this commentary, the authors draw from these works and the wider literature on longitudinal integrated educational design. They suggest that the confluences of movements for longitudinal integrated clerkships and entrustable professional activities open new possibilities for other educational and practice advancements in quality and safety. With the advent of competency-based education, explicit milestones, and improved assessment regimens, overseers will increasingly evaluate students, trainees, and other learners on their ability rather than relying solely on time spent in an activity. The authors suggest that, for such oversight to have the most value, assessors and learners need adequate oversight time, and redesign of educational models will serve this operational imperative. As education leaders are reassessing old medical school and training models, rotational blocks, and other barriers to progress, the authors explore the dynamic interplay between longitudinal integrated learning models and entrustment. PMID:24362396
Twelve tips for designing and running longitudinal integrated clerkships
Ellaway, Rachel; Graves, Lisa; Berry, Sue; Myhre, Doug; Cummings, Beth-Ann; Konkin, Jill
Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs. PMID:23883396
The Visiting Medical Student Clerkship Program at Mayo Clinic
Mueller, Paul S.; McConahey, Linda L.; Orvidas, Laura J.; Jenkins, Sarah M.; Kasten, Mary J.
OBJECTIVE: To describe the history, objectives, statistics, and initiatives used to address challenges associated with the Mayo Clinic Visiting Medical Student (VMS) Clerkship Program. MATERIALS AND METHODS: Mayo Clinic administrative records were reviewed for calendar years 1995 through 2008 to determine the effect of interventions to increase the numbers of appropriately qualified international VMSs and underrepresented minority VMSs. For numerical data, descriptive statistics were used; for comparisons, ?2 tests were performed. RESULTS: During the specified period, 4908 VMSs participated in the Mayo VMS Program (yearly mean [SD], 351 [24]). Most students were from US medical schools (3247 [66%]) and were male (3084 [63%]). Overall, 3101 VMSs (63%) applied for and 935 (30%) were appointed to Mayo Clinic residency program positions. Interventions to address the challenge of large numbers of international students who participated in our VMS program but did not apply for Mayo residency positions resulted in significantly fewer international students participating in our VMS program (P<.001), applying for Mayo residency program positions (P<.001), and being appointed to residency positions (P=.001). Interventions to address the challenge of low numbers of underrepresented minority students resulted in significantly more of these students participating in our VMS program (P=.005), applying for Mayo residency positions (P=.008), and being appointed to residency positions (P=.04). CONCLUSION: Our findings suggest that specific interventions can affect the characteristics of students who participate in VMS programs and who apply for and are appointed to residency program positions. PMID:20675510
The geriatric patient: Use of acute geriatrics units in the emergency care of elderly patients in France
D. Somme; C. Lazarovici; M. Dramé; P. Blanc; P. O. Lang; J. B. Gauvain; T. Voisin; R. Gonthier; B. De Wazičres; C. Jeandel; P. Couturier; F. Blanchard; O. Saint-Jean
We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics
Hematologic issues in the geriatric surgical patient.
Van, Philbert Y; Schreiber, Martin A
Geriatric patients are at higher risk for hemorrhagic complications after surgery and traumatic injuries. The geriatric population is more likely to take anticoagulant or antiplatelet medications. Chronic disease, autoimmune disease, and nutritional deficiencies can lead to coagulation factor and platelet disorders. One must be familiar with the current anticoagulant and antiplatelet medications, their mechanism of action, and reversal agents to properly care for this group of patients. The new oral anticoagulants do not have Food and Drug Administration (FDA) approved reversal agents, but known procoagulant agents with other FDA indications may be effective. PMID:25459547
[The emergent role of sarcopenia: Preliminary Report of the Observatory of Sarcopenia of the Spanish Society of Geriatrics and Gerontology].
Cruz-Jentoft, Alfonso J; Triana, Federico Cuesta; Gómez-Cabrera, Mari Carmen; López-Soto, Alfonso; Masanés, Ferran; Martín, Pilar Matía; Rexach, José Antonio Serra; Hidalgo, Domingo Ruiz; Salvŕ, Antoni; Vińa, José; Formiga, Francesc
Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics. PMID:21216498
Research Priorities for High Quality Geriatric Emergency Care: Medication Management, Screening and Prevention and Functional Assessment
Carpenter, Christopher R.; Heard, Kennon; Wilber, Scott; Ginde, Adit A.; Stiffler, Kirk; Gerson, Lowell W.; Wenger, Neal S.; Miller, Douglas K.
Background Geriatric adults represent an increasing proportion of emergency department (ED) users, and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus upon the development of quality indicators to define a minimal standard of care. Objectives The original objective of this project was to develop additional ED-specific quality indicators for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence was insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop quality indicators in the future. Methods Each domain was assigned one or two content experts who created potential quality indicators (QI) based on a systematic review of the literature, supplemented by expert opinion. Candidate quality indicators were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback. Results High-quality evidence based on patient-oriented outcomes was insufficient or non-existent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (3), screening and prevention (2), and functional assessment (3) are presented based upon proposed QIs that the majority of participants accepted. Conclusions In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future quality indicators within these domains are described. PMID:21676064
Geriatric Education in the Health Professions: Are We Making Progress?
Bardach, Shoshana H.; Rowles, Graham D.
Purpose: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies. Design and Methods: Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center. Findings: Geriatric training varies across health professions' disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training. Implications: Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula. PMID:22394495
INTERNSHIPS POLICY An internship (including externships, clerkships, student teaching or similar work experience) is
Hart, Gus
1 INTERNSHIPS POLICY April 2007 An internship (including externships, clerkships, student teaching of the student or the internship provider under policy established by the department/school internship oversight committee. INTERNSHIP ENROLLMENT AND EXPERIENCE The course numbers designated by the University Curriculum
How and What Do Medical Students Learn in Clerkships? Experience Based Learning (ExBL)
ERIC Educational Resources Information Center
Dornan, Tim; Tan, Naomi; Boshuizen, Henny; Gick, Rachel; Isba, Rachel; Mann, Karen; Scherpbier, Albert; Spencer, John; Timmins, Elizabeth
Clerkship education has been called a "black box" because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links…
Factors determining students' global satisfaction with clerkships: an analysis of a two year students' ratings database.
Durak, Halil Ibrahim; Vatansever, Kevser; van Dalen, Jan; van der Vleuten, Cees
Clerkships would benefit from teachers' improved understanding of the didactic aspects of their task. The purpose of this study is to identify factors that determine the teaching quality of clerkships and to examine the predictive value of these factors for students' global satisfaction. Thus, results would be further reflected to clinical teachers' tasks. These factors could then be taken into account in future clinical teaching. In this paper, a medical faculty's 2 year data set of student feedback from a systematic programme evaluation project was used. A factor analysis was performed on 11,780 student questionnaires. Factor loads, and the Cronbach's alpha coefficients of the questionnaire and factors were calculated. In order to examine the contributions of the factors to the students' global satisfaction, the study included a multivariate stepwise regression analysis. The analysis revealed four factors, which together explained 60.24% of the variance: Structure & Process (44.66%); Time (5.8 %); Outcome (5.35%) and Input (4.39%). The Structure & Process factor was found to be the best predictor of students' global satisfaction (R2 =( ).537). Our conclusion is that "efforts to improve clerkship quality should focus on students' learning processes and clerkship structure". PMID:17387625
Filling in the Gaps of Clerkship with a Comprehensive Clinical Skills Curriculum
ERIC Educational Resources Information Center
Veale, Pamela; Carson, Julie; Coderre, Sylvain; Woloschuk, Wayne; Wright, Bruce; McLaughlin, Kevin
Although the clinical clerkship model is based upon sound pedagogy, including theories of social learning and situated learning, studies evaluating clinical performance of residents suggests that this model may not fully meet the learning needs of students. Here our objective was to design a curriculum to bridge the learning gaps of the existing…
Do Clinical Evaluations in a Psychiatry Clerkship Favor Students with Positive Personality Characteristics?
ERIC Educational Resources Information Center
Chibnall, John T.; Blaskiewicz, Robert J.
Objective: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. Methods: Students completed the Revised NEO Personality…
Development of a longitudinal integrated clerkship at an academic medical center
Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E.; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J.; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia
In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center. PMID:21475642
Do Student Evaluations Influence the Teaching Skills of Clerkship Clinical Faculty?
ERIC Educational Resources Information Center
Chandrasekhar, Arcot J.; Durazo-Arvizu, Ramon; Hoyt, Amy; McNulty, John A.
Web-based student evaluations of clinical faculty were collected over an 8-year period. There were 19,881 medical student evaluations over the 8-year period for all clinical clerkships, representing a total of 952 faculty. Students used a 5-point Likert scale to rate the teaching effectiveness of faculty. Criterion-based methods and standard…
Using Multiple Assessments to Evaluate Medical Students' Clinical Ability in Psychiatric Clerkships
ERIC Educational Resources Information Center
Wang, Peng-Wei; Cheng, Cheng-Chung; Chou, Frank Huang-Chih; Tsang, Hin-Yeung; Chang, Yu-San; Huang, Mei-Feng; Yen, Cheng-Fang
Background: No single assessment method can successfully evaluate the clinical ability of medical students in psychiatric clerkships; however, few studies have examined the efficacy of multiple assessments, especially in psychiatry. The aim of this study was to examine the relationship among different types of assessments of medical students'…
Psychiatry in the Harvard Medical School-Cambridge Integrated Clerkship: An Innovative, Year-Long Program
ERIC Educational Resources Information Center
Griswold, Todd; Bullock, Christopher; Gaufberg, Elizabeth; Albanese, Mark; Bonilla, Pedro; Dvorak, Ramona; Epelbaum, Claudia; Givon, Lior; Kueppenbender, Karsten; Joseph, Robert; Boyd, J. Wesley; Shtasel, Derri
Objective: The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. Method: A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements…
Academic Performance in the Context of a "Three Excused Absences" Psychiatry Clerkship Policy
ERIC Educational Resources Information Center
Schillerstrom, Jason E.; Lutz, Mary
Objective: In order to better manage medical student absences during the psychiatry clerkship, a policy allowing students to miss up to 3 days without penalty was developed. The purpose of this study was to describe absence patterns and compare academic performance between students with and without absences. Method: Authors reviewed the academic…
Incorporating Active Learning into a Psychiatry Clerkship: Does It Make a Difference?
ERIC Educational Resources Information Center
Morreale, Mary; Arfken, Cynthia; Bridge, Patrick; Balon, Richard
Objective: Medical students' satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on…
The Effect of an End-of-Clerkship Review Session on NBME Psychiatry Subject Exam Scores
ERIC Educational Resources Information Center
Sidhu, Shawn S.; Chandra, Rohit M.; Wang, Lei; Gollan, Jacqueline K.; Rasminsky, Sonya; Brar, Simerjeet K.; Anzia, Joan M.
Objective: The NBME Psychiatry Subject Examination (PSE) is used throughout North America to test MS-III end-of-clerkship knowledge; yet, literature on PSE preparatory methods remains sparse. This study assesses the effect of a curriculum intervention on NBME PSE scores. Method: An optional 1.5-hour review session and accompanying…
Faculty Preparedness in Geriatric Optometry Education.
ERIC Educational Resources Information Center
Mancil, Gary L.; And Others
A survey of chief academic officers and faculty (n=27) in 16 schools of optometry found that, since 1986, there has been a 75% increase in institutions requiring coursework in geriatric optometry and an 83% increase in those offering continuing professional education in this field. However, 67% of faculty report no formal training. Three faculty…
A Review of Geriatric Education in Singapore
Loo Lin
The United Nations has identified the training and education of healthcare professionals and care providers involved in the care of older persons as a global priority. Singapore is no exception as it faces a rapidly ageing population. Older people have many medical needs of varying dimensions and their care requires a multidisciplinary healthcare team. The current status of geriatric education
Geriatric oncology research to improve clinical care.
Mohile, Supriya; Dale, William; Hurria, Arti
Cancer incidence increases with advanced age. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and NCI, have summarized the gaps in knowledge in geriatric oncology and made recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. Information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment, and to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study end points that address the needs of the older and/or vulnerable adult with cancer and to build a better infrastructure to accommodate the needs of older adults to improve their representation in trials. We use a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge of best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed. PMID:22825377
Geriatric Oncology Research to Improve Clinical Care
Mohile, Supriya; Dale, William; Hurria, Arti
Summary The incidence of cancer increases with advanced age. The Cancer and Aging Research Group (CARG), in partnership with the National Institute on Aging and National Cancer Institute, held a conference in September of 2010 which summarized the gaps in knowledge in geriatric oncology and recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. The information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment. CGA can also be used to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study endpoints that address the needs of the older and/or vulnerable adult with cancer and to build better infrastructure to accommodate the needs of older adults to improve their representation in trials. In this review, we utilize a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge regarding best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed given the rapid aging of the population. PMID:22825377
Geriatric Staff Training for Patient Independence.
ERIC Educational Resources Information Center
Hickey, Tom
The project investigated the effectiveness of an evironmental therapy training program for geriatric mental health workers when used in two different institutional settings. Site A was a State-operated facility for psychiatric in-patient care, accommodating 2,000 patients, with emphasis on maintenance and general patient welfare. Site B, a former…
David K Brown Geriatrics Scholar Program
Mohaghegh, Shahab
care of older adults in West Virginia by enhancing geriatrics training and competency of our state's health professionals that care for our older citizens. Our mission includes creating a sustainable policy and aging, community based care, managed and long term care, and health care service delivery
What's Behind a Name: The Kaufman Prize of the Canadian Geriatrics Society
Hogan, David B.
The Kaufman Prize has been given by the Canadian Geriatrics Society for nearly 30 years, but few Society members are aware of who Kaufman was or why the Prize was named after him. They are equally unclear about the objectives established for the Prize and how successful it has been in achieving them. This paper reviews the history of the Kaufman Prize and the eponymous A.R. Kaufman. The original objectives of the award were to encourage clinical research in geriatric medicine and to foster research interest in medical residents. Over the years the Prize has allowed the Society to both recognize and encourage excellence in age-related research among trainees. With the renaming of the Prize, now would be an opportune time for the Society to review both its objectives and its format. PMID:23251314
Natural products and supplements for geriatric depression and cognitive disorders: an evaluation of the research.
Varteresian, Taya; Lavretsky, Helen
Numerous geriatric patients are using Complementary and Alternative Medicine (CAM) for late-life mood and cognitive disorders. Natural products and supplements are a common CAM intervention which have risks and benefits of which patients should be appropriately advised. The data for omega-3 fatty acids, ginkgo biloba, SAMe, St John's wort, B vitamins and vitamin D, huperzine, caprylidene, and coconut oil will be evaluated. Since the evidence basis for natural products and supplements is limited, especially for the geriatric population, studies involving the general adult population are included to infer effects in the aging population. Despite the data available, more rigorous studies with larger sample sizes over longer periods of time are still needed. Regardless of a physician's preference to recommend various natural supplements and products, a physician could protect their patients by having an understanding of the side effects and indications for various natural products. PMID:24912606
Correlation between clinical clerkship achievement and objective structured clinical examination (OSCE) scores of graduating dental students on conservative dentistry
Bang, Jae-Beum
Objectives This study aimed to investigate the effect of clinical clerkship-associated achievements, such as performance of procedures at the student clinic, observation, and attitude towards a clerkship, on the objective structured clinical examination (OSCE) scores of dental students graduating in restorative dentistry. Materials and Methods The OSCEs consisted of two stations designed to assess students' clinical skills regarding cavity preparation for a class II gold inlay and a class IV composite restoration. The clerkship achievements, consisting of the number of student clinical procedures performed, observation-related OSCE, and scores of their attitudes towards a conservative dentistry clerkship, were assessed. Correlation and multiple regression analyses were conducted. Results The correlation coefficient between the OSCE scores for cavity preparation for a class II gold restoration and clerkship attitude scores was 0.241 (p < 0.05). Regarding a class IV composite restoration, OSCE scores showed statistically significant correlations with the observation (r = 0.344, p < 0.01) and attitude (r = 0.303, p < 0.01) scores. In a multiple regression analysis, attitudes towards a clerkship (p = 0.033) was associated with the cavity preparation for a class II gold inlay OSCE scores, while the number of procedure observations (p = 0.002) was associated with the class IV composite restoration OSCE scores. Conclusions The number of clinical procedures performed by students, which is an important requirement for graduation, showed no correlation with either of the OSCEs scores. PMID:23741710
Developing Leadership in Geriatric Education: An Annual Faculty Institute. Proceedings of the Summer Geriatric Institute (4th, Lexington, Kentucky, July 24-27, 1989).
ERIC Educational Resources Information Center
Gardner, Davis L., Ed.; Hoekelman, Margaret C., Ed.
This document presents the proceedings of a conference on geriatric education. These papers are included: Promoting Healthy Aging: A Leadership Role for Geriatric Education; National Research Priorities in Aging; Aging with a Disability; Recent Advances in Clinical Strategies in Geriatric Education: The Role of the Geriatric Nurse in the Acute…
Recognition of Depression in Geriatric ED Patients by Emergency Physicians
Stephen W Meldon; Charles L Emerman; Daniel SP Schubert
Study objective: To prospectively evaluate identification of geriatric depression by emergency physicians and to assess the utility of a self-rated depression scale to improve case-finding in geriatric patients presenting to the ED. Methods: We conducted an observational survey of geriatric ED patients who presented to an urban, university-affiliated public hospital. A brief self-rated depression scale was administered to 101 patients
Using Facebook Within a Geriatric Pharmacotherapy Course
Objective To evaluate using an Internet-based social networking site within an elective geriatric pharmacotherapy course. Design Thirty pharmacy students enrolled in a geriatric pharmacotherapy elective course were invited to join a closed Facebook (Facebook Inc, Palo Alto, CA) group to enhance communication among students and faculty members within the course. Creating a discussion board was the primary activity in the course. Each week, 3 students were assigned to post a healthy aging topic, and other students in the class were expected to post their comments and reactions. The healthy aging topics also were discussed during class. Assessment Students wrote reflections about their experiences using Facebook for the activities within this course. A survey instrument also measured students' opinions about using Facebook for educational purposes. Conclusion Using Facebook allowed students to discuss topics more openly and encouraged classroom discussions of healthy aging topics. PMID:21179256
[Geriatric assessment prior to oncological therapy].
Wedding, U
Ageing is the single most important risk factor for cancer. This is also true for most cancer diseases of the genitourinary tract. In combination with the demographic changes in Germany and most other countries, the consequence is a substantial increase in the number of elderly patients with cancer. Most therapies in oncology have a high risk for toxic side effects. Ageing is a very heterogeneous process. The chronological age of a patient insufficiently reflects the individual resources, deficits and risk factors but this can be assessed by a structured geriatric assessment. Integration of geriatric assessment into oncological treatment decisions is still low and is one of the major tasks in cancer care in the future. PMID:23708006
Dietary Intakes of Geriatric Patients in Hospital
Elizabeth Evans; Anne L. Stock
Individually weighed food intakes have been obtained over an 8-day period from 14 men (age range 63-91 years) 25 women (age range 61-94 years) resident in geriatric wards in an Essex hospital. Nutrient intakes have been computed from food composition tables vitamin C also by chemical analysis. Energy intakes were low compared with those obtained in other surveys, and were
[Geriatric dentistry: medical problems as well as disease- and therapy-induced oral disorders].
Koller, M M
As in pediatric dentistry, management of the oral problems in elderly patients does not depend on the development of new technical skills, but rather on the knowledge of: biological, psychological and social aspects of primary (physiological or age-related) and secondary (pathological or disease-related) aging; atypical presentations of disease; multiple pathological conditions (polymorbidity, polypathophysiology, polypharmacy); an underreporting of disease; the importance of functional status; the role of an interdisciplinary team; Geriatric medicine refers to social, psychological and clinical aspects of disease in older adults. Geriatric dentistry deals with the respective aspects concerning oral diseases. Chronic conditions as well as their treatment (e.g. medication) are more common with advancing age. They may have major implications for dental practice, leading to changes in oral health behavior and attitudes of the elderly patient with sometimes detrimental effects on oral health. Therefore, different concepts in prevention, diagnosis and therapy of oral diseases are required for the oral care of older adults. Two important consequences must be considered: Firstly, the medical education of the dentist and the dental team must be improved. The dental team must become a member of the group of health-care professionals caring for an aging population (geriatric medicine) to meet the heterogeneous needs of as much as 75% of our future patients. Secondly, there is great need for education of all health-care professionals dealing with elderly patients about possible negative impacts medicine can have on oral health. Identification and diagnosis of oral disease as well as preventive measures must be stressed. PMID:8153504
Geriatric trauma: resource use and patient outcomes
McKevitt, Elaine C.; Calvert, E.; Ng, A.; Simons, Richard K.; Kirkpatrick, Andrew W.; Appleton, Leanne; Brown, D. Ross G.
Introduction Elderly patients who suffer trauma have a higher mortality and use disproportionately more trauma resources than younger patients. To compare these 2 groups and determine the outcomes and characteristics of elderly patients, we reviewed patients in these 2 groups admitted and treated in our tertiary care provincial trauma centre. Methods From the provincial trauma registry we selected a cohort of 40 geriatric patients (group 1) (? 65 yr of age) with an ISS of16 or more who were admitted to and spent time in our trauma service for more than 48 hours and compared them with a similar randomly selected cohort of 44 patients (group 2) aged 20–30 years. Family physicians were contacted for follow-up of these patients 2 years after discharge. We considered length of hospital stay, complications, disposition of the patients and use of consultation services. esults Patients in group 1 had a mean age of 72.1 years (range from 65–98 yr) and a mean ISS of 27.3 (range from 17–50). Patients in group 2 had a mean age of 26.3 years (range from 22–29 yr) and a mean ISS of 26.3 (range from 17–54). Hospital stay was significantly longer in the group 1: 34.5 days (95% confidence interval [CI]: 24–44 d) versus 21.6 days (95% CI: 15–28 d). More elderly patients experienced complications (35 v. 13, p < 0.001) and required medical consultations (35 v. 26, p < 0.001). In-hospital death rates were 8% (3 of 40) and 4% (2 of 44) respectively (p = 0.3). Fewer geriatric patients could be discharged home (35% [14 of 40] v. 27% [22 of 44], p = 0.056) or to rehabilitation facilities (28% [11 of 40] v. 34% [15 of 44], p = 0.3). Five geriatric patients were discharged to nursing homes (p = 0.007). Of the geriatric patients discharged to rehabilitation facilities or home, 75% were independent 2 years after discharge. Conclusions Aggressive care for geriatric trauma patients is warranted, and resources should be directed toward rehabilitation. Based on our findings, we expect that creating a directed care pathway for these patients, targetting complications and earlier discharge, will further improve their outcomes. PMID:12812248
Medical Student Quality-of-Life in the Clerkships: A Scale Validation Study.
Brannick, Michael T; Horn, Gregory T; Schnaus, Michael J; Wahi, Monika M; Goldin, Steven B
Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research. PMID:25831183
Teaching methods in community health nursing clerkships: experiences of healthcare staff in Iran
Purpose: Healthcare staff educate nursing students during their clerkships at community health nursing programs. Their teaching methods play an important role in nursing students' acquisition of competencies; however, these methods have not been studied thoroughly. Thus, this study aims to describe, interpret, and understand the experiences of healthcare staff's teaching methods in clerkships at a community health nursing program. Methods: This study was conducted using purposeful sampling and semi-structured interviews with 13 members of the staff of three urban healthcare centers in Iran. The data were analyzed through qualitative content analysis and thematic analysis. Results: Multiplicity of teaching was identified as the main category of teaching method, and the five subcategories were teaching through lecture, demonstration, doing, visits and field trips, and readiness. The most common method used by the healthcare staff was lecturing. Conclusion: The healthcare staff used multiple methods to teach students in the nursing clerkship of the community health program, which was the strength of the course. However, they should be familiar with, and utilize additional methods, such as discussion rather than lecture. PMID:25273853
The Filipino Nursing Students' Dilemmas in Geriatric Care
ERIC Educational Resources Information Center
de Guzman, Allan B.; Cruz, Andrei Angelo R.; Cruz, Angela Laurice G.; Cruz, Robert Edward D.; Cuarto, Jose Mari Nino L.
The continually rising percentage of the elderly population and the demand for geriatric nursing care are dramatically related. While it is true that most undergraduate programs prepare nurses for the care of geriatric patients, most receive limited academic preparation in the nursing curriculum (Williams & Mezey, 2000). This is particularly true…
Physical, psychological, and social outcomes in geriatric rehabilitation patients
Robin A. Hanks; Peter A. Lichtenberg
Objective: Previous research studies that addressed the relationship between age and functional outcome had limited generalizability because of small sample size, lack of an urban population, and limited variables that do not allow for a complete investigation of social, cognitive, psychological, and medical factors in geriatric rehabilitation. The present study attempted to assess the relationship between decade of geriatric life
Clock drawing, clock copying, and physical abilities in geriatric rehabilitation
Robert A. Ruchinskas; Hedy K. Singer; Nancy K. Repetz
Ruchinskas RA, Singer HK, Repetz NK. Clock drawing, clock copying, and physical abilities in geriatric rehabilitation. Arch Phys Med Rehabil 2001;82;920-4. Objectives: To determine whether clock drawing and clock copying assess domains that are critical for successful rehabilitation and to evaluate the use of these tasks in predicting physical abilities during rehabilitation. Design: Observational survey study of geriatric cohorts. Setting:
The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.
Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P
The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. PMID:25644187
BJ Spitler: geriatric care management pioneer.
Frates, Janice
The late BJ Curry Spitler pioneered a new geriatric care management business model that combined care management with home health services and emphasized high levels of training and professionalism for all members of the caregiving team. After working with BJ to write a marketing plan emphasizing quality, I learned to appreciate what she did when my mother needed "assisted living at home" services from the firm. Thanks to BJ Curry Spitler and her vision of helping seniors age in place, more elders are able to remain independent in their own homes with dignity and safety, and peace of mind for their families. PMID:18510195
Summer 4th Year Elective Clerkships Elective Disciplines
Alford, Simon
II CELE 611 20830 Orthopaedics III CELE 611 20831 Orthopaedics IV Otolaryngology CELE 612 15314 Otolaryngology CELE 612 15315 Head and Neck Surgery CELE 613 20832 Special Topics-Otolaryngolgy CELE 613 20833 Research-Otolaryngology Pathology CELE 613 15316 Clinical Path/Lab Medicine CELE 613 15317 Surgical
Geriatrics in medical students' curricula: questionnaire-based analysis
Background Demographic development is accompanied by an increasingly aging society. Concerning medical education, the treatment of older people as well as the scientific research and exploration of ageing aspects in the coming years need to be considered. Aim of the study was to ascertain medical students' knowledge, interest, and attitudes regarding older patients and geriatric medicine. Methods Each participant completed a self-designed questionnaire. This questionnaire was based on three validated internationally recognised questionnaires ("Facts on Aging Quiz – FAQ", "Expectations Regarding Aging – ERA" and the "Aging Semantic Differential – ASD"). The inquiry and survey were performed at the beginning of the summer term in 2012 at the University of Regensburg Medical School. Results A total of n?=?184/253 (72.7%) students participated in this survey. The results of the FAQ 25+ showed that respondents were able to answer an average of M?=?20.4 of 36 questions (56.7%) correctly (Median, Md?=?21; SD ±6.1). The personal attitudes and expectations of ageing averaged M?=?41.2 points on the Likert-scale that ranged from 0 to 100 (Md?=?40.4; SD ±13.7). Respondents' attitudes towards the elderly (ASD 24) averaged M?=?3.5 points on the Likert-scale (range 1–7, Md 3.6, SD ±0.8). Conclusions In our investigation, medical students' knowledge of ageing was comparable to previous surveys. Attitudes and expectations of ageing were more positive compared to previous studies. Overall, medical students expect markedly high cognitive capacities towards older people that can actively prevent cognitive impairment. However, medical students' personal interest in medicine of ageing and older people seems to be rather slight. PMID:25062568
[Clinical practice guideline: a complete geriatric evaluation].
Medina-Chávez, Juan Humberto; Torres-Arreola, Laura Del Pilar; Cortés-González, Rosa María; Durán-Gómez, Verónica; Martínez-Hernández, Fernando; Esquivel-Romero, Gustavo
The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly. PMID:22176832
Geriatric dyspnea: doing worse, feeling better.
Petersen, Sibylle; von Leupoldt, Andreas; Van den Bergh, Omer
Older age is associated with a decline in physical fitness and reduced efficiency of the respiratory system. Paradoxically, it is also related to reduced report of dyspnea, that is, the experience of difficult and uncomfortable breathing. Reduced symptom reporting contributes to misdiagnosis or late diagnosis of underlying disease, suboptimal treatment, faster disease progression, shorter life expectancy, lower quality of life for patients, and considerably increased costs for the health care system in an aging society. However, pathways in the complex relationship between dyspnea and age are not well explored yet. We propose a model on geriatric dyspnea that integrates physiological, neurological, psychological and social pathways which link older age with dyspnea perception and expression. We suggest that the seemingly paradox of reduction of dyspnea in older age, despite physiological decline, can be solved by taking age-related changes on these multiple levels into account. In identifying these variables, the Geriatric Dyspnea Model highlights risk factors for reduced dyspnea perception and report in older age and pathways for intervention. PMID:24675044
[Nutritional guidelines and standards in geriatrics].
Volkert, D
Nutritional problems and deficiencies are widespread in geriatric institutions. On the other hand, benefits of different interventions to improve the nutritional situation of elderly people--from amelioration of mealtime ambience to the use of artificial nutrition--have been shown in many studies. In recent years, several guidelines and standards have been developed to facilitate the transfer of this scientific knowledge into practice. These are in particular the medical Guidelines for Enteral and Parenteral Nutrition in Geriatrics (DGEM/DGG and ESPEN), the DNQP Expert Standard for qualified nurses, the DGE Quality Standards for dietetic personnel, and the interdisciplinary BUKO-QS Standard. These guidelines and standards provide recommendations for adequate nutritional care and assistance for the institutionalized elderly person based on the scientific state of the art. They should be used as the basis for the development of local instructions for the management of nutritional problems and malnutrition. Elderly people will only profit, if these guidelines are used in daily routine. PMID:21494930
ESPEN Guidelines on Enteral Nutrition: Geriatrics.
Volkert, D; Berner, Y N; Berry, E; Cederholm, T; Coti Bertrand, P; Milne, A; Palmblad, J; Schneider, St; Sobotka, L; Stanga, Z; Lenzen-Grossimlinghaus, R; Krys, U; Pirlich, M; Herbst, B; Schütz, T; Schröer, W; Weinrebe, W; Ockenga, J; Lochs, H
Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent. PMID:16735082
Current publications in Gerontology and Geriatrics.
Shock, N W
The subject categories are those in A Classified Bibliography of Gerontology and Geriatrics by Nathan W. Shock, published by Stanford University Press, Stanford, California (1951). Only major headings are used and the Roman numerals correspond to those given in the bibliography. Insofar as possible, references are classified according to organ systems. Thus, most of the material on Geriatrics will be found under the organ system involved in the disease. Cross references are indicated by numbers at the end of each section. When available, abstract references are given (B.A.-Biological Abstracts. P.A.-Psychological Abstracts, and P.I.-Population Index). Abbreviations for journals are those in A World List of Scientific Periodicals Published in the years 1900-1933, 2nd Edition. For journals not listed, abbreviations were devised to the general rules used in the above source. It is impossible to cover all journals and list all papers concerned with aging and the aged. Authors and publishers are requested to call attention to publications or to send reprints to the Gerontology Research Center, Baltimore City Hospitals, Baltimore, Maryland 21224. PMID:376580
Current publications in gerontology and geriatrics.
Shock, N W
THE SUBJECT categories are those in A Classified Bibliography of Gerontology and Geriatrics by Nathan W; Shock, published by Stanford University Press, Stanford, California (1951). Only major headings are used and the Roman numerals correspond to those given in the bibliography. Insofar as possible, references are classified according to organ systems. Thus, most of the material on Geriatrics will be found under the organ system involved in the disease. Cross references are indicated by numbers at the end of each section. When available, abstract references are given (B.A.--Biological Abstracts. P.A.--Psychological Abstracts, and P.I.-Population Index). Abbreviations for journals are those in A World List of Scientific Periodicals Published in the years 1900-1933; 2nd Edition. For journals not listed, abbreviations were devised to the general rules used in the above source. It is impossible to cover all journals and list all papers concerned with aging and the aged. Authors and publishers are requested to call attention to publications or to send reprints to the Gerontology Research Center, Baltimore City Hospitals, Baltimore, Maryland 21224. PMID:325062
Improving the quality of geriatric nursing care: enduring outcomes from the geriatric nursing education consortium.
Gray-Miceli, Deanna; Wilson, Laurie Dodge; Stanley, Joan; Watman, Rachael; Shire, Amy; Sofaer, Shoshanna; Mezey, Mathy
The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted. PMID:25455325
Geriatric education in undergraduate and graduate levels in Latin America.
López, Jorge H; Reyes-Ortiz, Carlos A
A recent dramatic increase in the elderly population has not been accompanied by a parallel increase in specialized health care professionals in Latin America. The main purpose of this work was to determine the stage of geriatrics teaching for undergraduate and graduate medical levels in Latin America. Using a questionnaire given in person and online, the authors surveyed geriatricians from 16 countries: eight from South America and eight from Central America. Among 308 medical schools, 35% taught undergraduate geriatrics, ranging from none in Uruguay, Venezuela, and Guatemala to 82% in Mexico. The authors identified 36 programs in 12 countries with graduate medical education in geriatrics, ranging from 2 to 5 years of training. The authors conclude that although the population is aging rapidly in Latin American countries, there has been a slow development of geriatrics teaching at undergraduate and postgraduate levels in the region. PMID:24717013
Empathy Training as an Instructional Tool for Geriatric Health Professionals.
ERIC Educational Resources Information Center
Hubbard, Richard W.; Santos, John F.
Reports the simulation of sensory and mobility problems of older adults as an effective training model when combined with a number of roles and scenarios. Discusses the application of the training model in work with geriatric health professionals. (Author)
Humanities and Geriatric Education: a Strategy for Recruitment?
Frank, Christopher; Martin, Ruth Elwood
Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees' attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching. PMID:25825611
Grading Medical Students in a Psychiatry Clerkship: Correlation with the NBME Subject Examination Scores and Its Implications
ERIC Educational Resources Information Center
Ramchandani, Dilip
Background/Objective: The author analyzed and compared various assessment methods for assessment of medical students; these methods included clinical assessment and the standardized National Board of Medical Education (NBME) subject examination. Method: Students were evaluated on their 6-week clerkship in psychiatry by both their clinical…
Description and impact of using a standard-setting method for determining pass\\/fail scores in a surgery clerkship
Nancy Schindler; Julia Corcoran; Debra DaRosa
BackgroundResearch on performance evaluation highlights the importance of using multiple measures to develop an accurate profile of students, yet we found no literature describing the use of a standard-setting method for determining a pass\\/fail cutoff for a clerkship based on multiple assessment methods.
[The need for training in gerontology and geriatrics among the staff providing services at a geriatric care institution].
Baerga Duperoy, Rachel; Castro Rojas, Nydia; Orta Rodríguez, Brenda; González Caraballo, Enid; Cruz González, Angel; Vázquez Fernández, José; Oliver Vázquez, Marlén
The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients. PMID:12572242
Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome.
Ahearn, David J; Umapathy, Dolores
Research to identify whether dizziness is a geriatric syndrome has largely overlooked often treatable vestibular causes. To ascertain the degree to which vestibular and other causes of dizziness interact in older people, an eight-month retrospective case-note review was undertaken in patients aged ?: 65 years referred with dizziness or imbalance to an audiovestibular medicine clinic. Of 41 patients aged 65-93 years old, 15 (37%) had multiple symptom triggers, 23 (56%) had recent dizziness-related falls, 24 (59%) and 10 (24%) had peripheral and central vestibular causes for dizziness respectively, whereas 6 (15%) had both. Sixteen (39%) had benign paroxysmal positional vertigo, of which 13 (32%) had an additional peripheral vestibular impairment. Twenty-six (63%) had other (general medical/cardiac) causes; of these 13 (50%) also had vestibular causes. Polypharmacy, orthostatic hypotension, psychotropic drug use and anxiety were common contributory factors. Vestibular causes of dizziness contribute to a multifactorial geriatric syndrome. All patients with dizziness and falls should have a vestibular assessment (especially peripheral) to improve quality of life and reduce falls. PMID:25650194
Clinical Conundrums in Management of Hypothyroidism in Critically Ill Geriatric Patients
Sehgal, Vishal; Bajwa, Sukhminder Jit Singh; Sehgal, Rinku; Bajaj, Anurag
Context: Articles in various international and national bibliographic indices were extensively searched with an emphasis on thyroid and hypothyroid disorders, hypothyroidism in elderly hospitalized patients, hypothyroidism in critically ill geriatric population, thyroxine in elderly hypothyroid, drug interactions and thyroid hormones, and thyroid functions in elderly. Evidence acquisition: Entrez (including PubMed), NIH.gov, Medscape.com, WebMD.com, MedHelp.org, Search Medica, MD consult, yahoo.com, and google.com were searched. Manual search was performed on various textbooks of medicine, critical care, pharmacology, and endocrinology. Results: Thyroid function tests in elderly hospitalized patients must be interpreted with circumspection. The elderly are often exposed to high iodide content and critical care settings. This may occur because of either decreased iodine excretion or very high intake of iodine. This is especially true for elderly population with underlying acute or chronic kidney diseases or both. Amiodarone, with a very high iodine content, is also often used in this set of population. Moreover, other medications including iodinated contrast are often used in the critical care settings. These may affect different steps of thyroid hormone metabolism, and thereby complicate the interpretation of thyroid function tests. Conclusions: The current review is aimed at analyzing and managing various clinical aspects of hypothyroidism in hospitalized elderly, and critically ill geriatric patients. PMID:24719636
Creation of a novel, interdisciplinary, multisite clerkship: "understanding lupus".
Nambudiri, Vinod E; Newman, Lori R; Haynes, Harley A; Schur, Peter; Vleugels, Ruth Ann
Few medical school electives include longitudinal patient care across clinical specialties and environments. Systemic lupus erythematosus represents a disease process with complex pathophysiology for students to learn from providers across medical fields, including dermatology, rheumatology, nephrology, and cardiology, in both pediatric and adult patients. Diagnosis, understanding, and management of lupus also rely heavily on basic science and clinical immunology, providing a link to the preclinical curriculum. In 2009, Harvard Medical School introduced a one-month elective course "Understanding Lupus: A Multidisciplinary Approach to Systemic Disease," designed to provide students with both outpatient and inpatient care experiences in dermatology, rheumatology, and multidisciplinary clinics at Brigham and Women's Hospital and Boston Children's Hospital. Core components of the elective include a continuity experience that allows students to attend one patient's multiple specialist visits; didactics from dermatology, rheumatology, and immunology covering evidence-based medicine and basic sciences; and clinical immunology laboratory exposure to teach serologic and auto-antibody testing methods. The authors provide lessons learned in the development of this interdisciplinary, multi-institution elective rotation, which may serve as a model at other medical schools for incorporating basic sciences into the clinical curriculum and using multidisciplinary care and varied educational settings. PMID:24448033
77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education, and...
78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education, and...
78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
78 FR 55778 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting
Federal Register 2010, 2011, 2012, 2013, 2014
...Health Administration (VHA) strategic planning activities in geriatrics and extended care; recent VHA efforts regarding dementia and program advances in palliative care; and performance and oversight of VA Geriatric Research, Education, and...
Effects of environmental agents on social behavior of geriatric residents in an institution dining room
Davies, Kimberly D
it for appropriateness for a geriatric population. Behavior of geriatric residents in a retirement community is assessed in accordance with minor changes made in their dining room environment. Observed behavior included the amount of time residents spent in the dining...
Geriatric-Focused Educational Offerings in the Department of Veterans Affairs from 1999 to 2009
ERIC Educational Resources Information Center
Thielke, Stephen; Tumosa, Nina; Lindenfeld, Rivkah; Shay, Kenneth
The scope of geriatrics-related educational offerings in large health care systems, in either the target audiences or topics covered, has not previously been analyzed or reported in the professional literature. The authors reviewed the geriatrics-related educational sessions that were provided between 1999 and 2009 by the Geriatrics Research,…
Association of APOE Genetic Polymorphism with Cognitive Function and Suicide History in Geriatric Depression
Jen-Ping Hwang; Chen-Hong Yang; Chen-Jee Hong; Jiing-Feng Lirng; Ya-Min Yang; Shih-Jen Tsai
Apolipoprotein E (APOE) has been associated with a variety of late-life neuropsychiatric disorders, including geriatric depression. This study determined whether APOE genotypes affect vulnerability to geriatric depression. We also tested the effect of the presence of the APOE ε4 (APOE4) allele on age of onset, suicide attempt history and cognitive function in geriatric depressed patients. We genotyped APOE in 111
Geriatric rehabilitation of stroke patients in nursing homes: a study protocol
Monica Spruit-van Eijk; Bianca I Buijck; Sytse U Zuidema; Frans LM Voncken; Alexander CH Geurts; Raymond TCM Koopmans
BACKGROUND: Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these
Managing a traumatic wound in a geriatric patient.
Glenn, Josephine
Clinical management of a wound in a geriatric patient requires an understanding of age-related changes in the skin and the knowledge to make appropriate treatment choices. This case study describes clinical assessment and management of a traumatic hip wound in a 75-year-old patient. In addition to addressing his nutritional status by providing supplements, topical wound care preparations, including papain-urea and castor oil/balsam of Peru/trypsin, were used as a conservative approach to address debridement and periwound skin concerns. Extra vigilance is required to assess wounds in geriatric patients to determine proper wound treatment and achieve optimum results. Additional studies to evaluate optimal treatment strategies in the clinical management of traumatic wounds in the geriatric population are needed. PMID:16636366
[Health care of geriatric patients with urinary incontinence].
Mueller, Edgar A; Kirch, Wilhelm
Urinary incontinence occurs frequently in geriatric patients. In the doctor's practice, the symptoms are often not mentioned by the patients; this may lead to loss of autonomy and social isolation. A screening for urinary incontinence should therefore be part of each geriatric assessment. In the presence of urinary incontinence, several treatment options are available, which need to be tailored according to the individual capabilities (mobility, motivation and cognitive performance) of the patient. Non-pharmacological treatment options, such as behavior modification, toilet training and pelvic floor training, should be exploited before any pharmacotherapy commences. If the pharmacological treatment involves the use of anticholinergic agents, the cognitive performance should be monitored. An interdisciplinary collaboration is a prerequisite for the optimized treatment and adequate health care of geriatric patients with urinary incontinence. PMID:25826038
A full revolution: offering 360 degree library services to clinical clerkship students.
Skhal, Kathryn J
In their third year, medical students transition from the classroom to the hospital. Librarians can ease this transition from assignment-based to patient-based information needs, and at the University of Iowa this takes many forms. Preparation begins in the second year with foundational instruction. Customized electronic resource centers aid in selection of specialized resources; demonstrations at clerkship orientations promote these centers; attending morning reports show a librarian on the clinical team; and exercises assess the ability to find quality answers quickly. This combination has improved the students' searching facility and their comfort with library staff. Data show student resource selection became varied and appropriate, although understanding of study designs is suboptimal. Feedback has been positive from both students and faculty. While these techniques have been successful, they are only the first step in an evolving program. PMID:19042706
Association of Cancer With Geriatric Syndromes in Older Medicare Beneficiaries
Mohile, Supriya G.; Fan, Lin; Reeve, Erin; Jean-Pierre, Pascal; Mustian, Karen; Peppone, Luke; Janelsins, Michelle; Morrow, Gary; Hall, William; Dale, William
Purpose To identify whether a history of cancer is associated with specific geriatric syndromes in older patients. Patients and Methods Using the 2003 Medicare Current Beneficiary Survey, we analyzed a national sample of 12,480 community-based elders. Differences in prevalence of geriatric syndromes between those with and without cancer were estimated. Multivariable logistic regressions were used to evaluate whether cancer was independently associated with geriatric syndromes. Results Two thousand three hundred forty-nine (18%) reported a history of cancer. Among those with cancer, 60.3% reported one or more geriatric syndromes as compared with 53.2% of those without cancer (P < .001). Those with cancer overall had a statistically significantly higher prevalence of hearing trouble, urinary incontinence, falls, depression, and osteoporosis than those without cancer. Adjusting for possible confounders, those with a history of cancer were more likely to experience depression (adjusted odds ratio [OR], 1.15; 95% CI, 1.02 to 1.30; P = .023), falls (adjusted OR, 1.17; 95% CI, 1.04 to 1.32; P = .010), osteoporosis (adjusted OR, 1.21; 95% CI, 1.06 to 1.38; P = .004), hearing trouble (adjusted OR, 1.28; 95% CI, 1.08 to 1.52; P = .005), and urinary incontinence (adjusted OR, 1.42; 95% CI, 1.20 to 1.69; P < .001). Analysis of specific cancer subtypes showed that lung cancer was associated with vision, hearing, and eating trouble; prostate cancer was associated with incontinence and falls; cervical/uterine cancer was associated with falls and osteoporosis; and colon cancer was associated with depression and osteoporosis. Conclusion Elderly patients with cancer experience a higher prevalence of geriatric syndromes than those without cancer. Prospective studies that establish the causal relationships between cancer and geriatric syndromes are necessary. PMID:21402608
Economic viability of geriatric hip fracture centers.
Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph
Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors' home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers. PMID:24579222
Management of fractures in a geriatric surgical patient.
Tinubu, Jide; Scalea, Thomas M
Trauma is an increasingly common problem in geriatric patients; fractures are frequent among the elderly. Life expectancy continues to rise. Advances in medical care allow people to live longer and better lives. Medications, surgical advances (treatment for coronary artery disease, coronary bypass grafting), and joint replacement surgery can be safely performed in elderly patients. Thus, geriatric patients are no longer confined to a life of inactivity. They are out of their homes and interacting in the community, exercising and leading active lives. Thus, they are more likely to become injured and present to trauma centers for care. PMID:25459546
An evaluation of provider educational needs in geriatric care.
Larson, James S; Chernoff, Ronni; Sweet-Holp, Tim J
Providers of geriatric care in Arkansas were surveyed to determine the desire for more information on their specialty as well as opportunities for further training. Those in the nursing profession were most interested in further training, and the major area of interest for all providers was in cognitive decline and mental health information. Specifically, information was sought in the areas of dementia, depression, and memory loss. It is recommended that improvement in geriatric care in the future should focus on nursing education and on raising the level of knowledge and academic prestige in the treatment of elderly patients, especially in the mental health areas. PMID:14994562
Research Priorities in Geriatric Palliative Care: Policy Initiatives
Unroe, Kathleen T.
Abstract Coordinated palliative care matched to patient needs improves quality of care for vulnerable patients with serious illness and reduces costly use of hospitals and emergency departments. Unfortunately, there is a disconnect in translating geriatric palliative care models and principles into policy and widespread practice. Gaps in policy-relevant research are addressed, including implementation strategies to scale up existing care models, the role of palliative care and geriatrics in health care payment reform efforts, development of quality measures for complex patients, strategies to address workforce shortages, and an approach to hospice reform. PMID:24147877
[The future of vascular medicine].
Kroeger, K; Luther, B
In the future vascular medicine will still have a great impact on health of people. It should be noted that the aging of the population does not lead to a dramatic increase in patient numbers, but will be associated with a changing spectrum of co-morbidities. In addition, vascular medical research has to include the intensive care special features of vascular patients, the involvement of vascular medicine in a holistic concept of fast-track surgery, a geriatric-oriented intensive monitoring and early geriatric rehabilitation. For the future acceptance of vascular medicine as a separate subject area under delimitation of cardiology and radiology is important. On the other hand, the subject is so complex and will become more complex in future specialisations that mixing of surgery and angiology is desirable, with the aim to preserve the vascular surgical knowledge and skills on par with the medical and interventional measures and further develop them. Only large, interdisciplinary guided vascular centres will be able to provide timely diagnosis and therapy, to deal with the growing multi-morbidity of the patient, to perform complex therapies even in an acute emergency and due to sufficient number of cases to present with well-trained and experienced teams. These requirements are mandatory to decrease patients' mortality step by step. PMID:25313887
Geriatric pain competencies and knowledge assessment for nurses in long term care settings
Swafford, Kristen L.; Miller, Lois L.; Herr, Keela; Forcucci, Chris; Kelly, Anne Marie L.; Bakerjian, Debra
Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings. PMID:25037079
A Geriatric Day Hospital: Who Improves the Most?
ERIC Educational Resources Information Center
Desrosiers, Johanne; Hebert, Rejean; Payette, Helene; Roy, Pierre-Michel; Tousignant, Michel; Cote, Sylvie; Trottier, Lise
This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric…
Rasch Analysis of the Geriatric Depression Scale--Short Form
ERIC Educational Resources Information Center
Chiang, Karl S.; Green, Kathy E.; Cox, Enid O.
Purpose: The purpose of this study was to examine scale dimensionality, reliability, invariance, targeting, continuity, cutoff scores, and diagnostic use of the Geriatric Depression Scale-Short Form (GDS-SF) over time with a sample of 177 English-speaking U.S. elders. Design and Methods: An item response theory, Rasch analysis, was conducted with…
External Validity of a Geriatric Food Behavior Instrument
NL Fey-Yensan; CM Capacchione; J Backstrand
LEARNING OUTCOME: To demonstrate the external validity of a self-administered food behavior instrument for older personsThe Geriatric Food Behavior Instrument (GFBI) has been demonstrated to measure eight valid and reliable constructs of food behavior that reflect nutritional risk for an older population. Construct validity was determined using principal components analysis with reliability coefficients (Cronbach's Alpha) of seven extracted components exceeding
Food intakes and preferences of hospitalised geriatric patients
Suzana Shahar; Kan Yin Chee; Wan Chak Pa' Wan Chik
BACKGROUND: A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. METHODS: Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors
Dietary Intake of a Group of Chronic Geriatric Psychiatric Patients
Merville Vincent; Rosalind S. Gibson
The nutrient intakes of 19 chronic geriatric psychiatric patients were determined by recording all food items consumed over a 3-day period and evaluated using the Canadian Dietary Standard. Mean intakes exceeded the recommendations of the Canadian Dietary Standard for calories and all nutrients except calcium, vitamin D, free folate and zinc. Wide individual variations in nutrient intakes were observed. Supplementation
Geriatric Knowledge and Educational Needs among Rural Health Care Professionals.
ERIC Educational Resources Information Center
Goins, R. Turner; Gainor, Sara Jane; Pollard, Cecil; Spencer, S. Melinda
In a needs assessment of 84 rural health care professionals (44.1% physicians, 15.5% pharmacists, 14.3% nurses, 26.1% other), 39% considered their geriatrics knowledge above average. They were interested in learning more about Alzheimer's/dementia, medication use, and adverse effects. Preferred methods were videotapes, CD-ROM, and an…
Neuroplasticity-Based Computerized Cognitive Remediation for Geriatric Depression
Morimoto, Sarah Shizuko; Wexler, Bruce E.; Alexopoulos, George S.
Objective This article describes a novel treatment model designed to target specific neurocognitive deficits in geriatric depression with neuroplasticity-based computerized cognitive remediation (NBCCR). Method The recent National Institute of Mental Health (NIMH) report "From Discovery to Cure" calls for studies focusing on mechanisms of treatment response with the goal of arriving at new interventions for those who do not respond to existing treatments. We describe the process that led to the identification of specific executive deficits and their underlying neurobiology, as well as the rationale for targeting these symptoms as a part of a strategy intended to improve both executive dysfunction and depression. We then propose a strategy for further research in this emerging area Results and Conclusions Despite significant developments, conventional antidepressant treatments leave many older adults still depressed and suffering (Thase, Entsuah et al. 2001). Psychotherapy may be effective in some depressed elders, although a recent review concluded that none of the available treatment studies meets stringent criteria for efficacy in the acute treatment of geriatric depression(Kiosses, Leon et al.). Appropriately developed and targeted NBCCR, has the potential to serve as a novel treatment intervention for geriatric depression. Pathophysiological changes associated with executive dysfunction may be an appropriate target for NBCCR. Examining both behavioral changes and indices of structural integrity and functional change of networks related to cognitive and emotional regulation may lead to a novel treatment and elucidate the role of specific cerebral networks in geriatric depression. PMID:22451346
Geriatric Dentistry and Prevention: Research and Public Policy
J. A. Gershen
Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and
Health Promotion/Disease Prevention: New Directions for Geriatric Education.
ERIC Educational Resources Information Center
Levkoff, Sue; And Others
Describes 10 modules for primary care practitioners on health promotion/disease prevention for the elderly on these topics: Alzheimer's disease in minorities, dehydration, diabetes, elder abuse, geriatric nutrition, oncology, oral health in long-term care, incontinence, injury prevention, and physical activity. These areas are significant for…
Clinical conundrums and challenges during geriatric orthopedic emergency surgeries
Bajwa, Sukhminder Jit Singh
Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population.
Geriatric Training Needs of Nursing-Home Physicians
ERIC Educational Resources Information Center
Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur
Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…
1 | P a g e David K Brown Geriatrics
Mohaghegh, Shahab
and health care of older adults in West Virginia by enhancing geriatrics training and competency of our state's health professionals that care for our older citizens. Our mission includes creating a sustainable's Center on Aging, was a beloved professor specializing in public policy and aging, community based care
Family Perceptions of Geriatric Foster Family and Nursing Home Care.
ERIC Educational Resources Information Center
Braun, Kathryn L.; Rose, Charles L.
Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…
Maximizing the Potential of Internships in Gerontology and Geriatrics
ERIC Educational Resources Information Center
Karasik, Rona J.
Internships and similar applied opportunities have long been valued for providing students with opportunities for practical experience, career preparation, and personal growth. The need for applied experiences in gerontology and geriatrics is particularly salient. Creating and sustaining effective internship experiences, however, requires careful…
Novel ethical dilemmas arising in geriatric clinical practice.
Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peńa, Carmen; Altamirano-Bustamante, Myriam M
The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. PMID:25185872
Pre-operative evaluation needed to detect geriatric syndromes.
Traditional peri-operative risk assessment measures might overlook geriatric-specific syndromes. A clear understanding of post-operative recovery and complication rates is important so that discussions can take place with patients and their families and realistic treatment goals can be set. PMID:25727629
The survey of opinions regarding good death for geriatric patients from the perspectives of geriatric patients and physicians
S Kornbongkotmas; V Srinonprasert; A Kajornkitjaroen; R Praditsuwan
Nowadays growing concern over providing the best possible end-of-life care for geriatric patients has been raised worldwide. It is not uncommon that different perspectives of patients, families and caring physicians may result in unwanted suffering of dying patients. Learning the differences might lead to appropriate interventions and bring about better quality of care for older patients toward the end of
Use of Geriatric Assessment for Older Adults in the Oncology Setting: A Systematic Review
Background Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult's medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). Methods We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. Results We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10–45min. Geriatric assessment was most often completed to describe a patient's health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%–50% of treatment decisions. Conclusion Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed. PMID:22851269
American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Campanelli, Christine M.
Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes. PMID:22376048
[Gerodontology consultation in geriatric facilities: general health status (I)].
Katsoulis, Joannis; Huber, Sandra; Mericske-Stern, Regina
Dental undertreatment is often seen in the older population. This is particularly true for the elderly living in nursing homes and geriatric hospitals. The progression of chronic diseases results in loss of their independence. They rely on daily support and care due to physical or mental impairment. The visit of a dentist in private praxis becomes difficult or impossible and is a logistic problem. These elderly patients are often not aware of oral and dental problems or these are not addressed. The geriatric hospital Bern, Ziegler, has integrated dental care in the concept of physical rehabilitation of geriatric patients. A total of 139 patients received dental treatment in the years 2005/2006. Their mean age was 83 years, but the segment with > 85 years of age amounted to 46%. The general health examinations reveald multiple and complex disorders. The ASA classification (American Society of Anesthesiologists, Physical Status Classification System) was applied and resulted in 15% = P2 (mild systemic disease, no functional limitation), 47% = P3 (severe systemic disease, definite functional limitations) and 38% = P4 (severe systemic disease, constant threat to life). Eighty-seven of the patients exhibited 3 or more chronic diseases with a prevalence of cardiovascular diseases, musculoskelettal disorders and dementia. Overall the differences between men and women were small, but broncho-pulmonary dieseases were significantly more frequent in women, while men were more often diagnosed with dementia and depression. Verbal communication was limited or not possible with 60% of the patients due to cognitive impairment or aphasia after a stroke. Although the objective treatment need is high, providing dentistry for frail and geriatric patients is characterized by risks due to poor general health conditions, difficulties in communication, limitations in feasibility and lack of adequate aftercare. In order to prevent the problem of undertreatment, elderly independently living people should undergo dental treatment regularly and in time. Training of nurses and doctors of geriatric hospitals in oral hygiene should improve the awareness. A multidisciplinary assessment of geriatric patients should include the oral and dental aspect if they enter the hospital. PMID:19227801
Using tablets to support self-regulated learning in a longitudinal integrated clerkship
Alegría, Dylan Archbold Hufty; Boscardin, Christy; Poncelet, Ann; Mayfield, Chandler; Wamsley, Maria
Introduction The need to train physicians committed to learning throughout their careers has prompted medical schools to encourage the development and practice of self-regulated learning by students. Longitudinal integrated clerkships (LICs) require students to exercise self-regulated learning skills. As mobile tools, tablets can potentially support self-regulation among LIC students. Methods We provided 15 LIC students with tablet computers with access to the electronic health record (EHR), to track their patient cohort, and a multiplatform online notebook, to support documentation and retrieval of self-identified clinical learning issues. Students received a 1-hour workshop on the relevant features of the tablet and online notebook. Two focus groups with the students were used to evaluate the program, one early and one late in the year and were coded by two raters. Results Students used the tablet to support their self-regulated learning in ways that were unique to their learning styles and increased access to resources and utilization of down-time. Students who used the tablet to self-monitor and target learning demonstrated the utility of tablets as learning tools. Conclusions LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students' ability to develop and employ self-regulatory skills in a clinical context. PMID:24646438
Insomnia symptoms and their correlates among the elderly in geriatric homes in Alexandria, Egypt
Mohamed M. Makhlouf; Abla I. Ayoub; Moataz M. Abdel-Fattah
The prevalence of sleep complaints increases steadily with age. Studies investigating insomnia among elderly people living\\u000a in geriatric homes, especially among Egyptians, are scarce. This study aimed to determine the prevalence of insomnia symptoms\\u000a among the elderly living in geriatric homes in Alexandria and their correlates. A cross-sectional survey of a representative\\u000a sample of elderly population of geriatric homes in
Expectations of patients, nurses and physicians in geriatric nursing home emergencies
M. K. Bluemel; C. Traweger; J. F. Kinzl; M. A. Baubin; W. Lederer
ObjectivesTo determine contentment with the performance of primary mission emergency care providers.MethodsA prospective cohort study was conducted using key informant interviews to assess quality of life and self-rated degree of contentment with care in geriatric emergencies.ResultsInterviews concerning a total of 152 geriatric emergency cases in nursing homes were conducted with patients in 13 (8.6%) cases, geriatric nurses in 132 (86.8%)
Geriatric Rehabilitation Patients' Perceptions of Unit Dining Locations
Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne
Background Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients' perceptions regarding meals in a common dining area versus at the bedside. Methods An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Results Eating location was influenced by compliance with the perceived rules of the unit, physical and emotional well-being, and quarantine orders. Certain participants preferred eating in the common dining room where they had more assistance from hospital staff, a more attractive physical environment, and the opportunity to socialize. However, other participants preferred eating at their bedsides, feeling the quality of social interaction was poor in the dining room. Conclusions Participants' experiences of, and preferences for, communal dining differed. If the benefits of communal dining are to be maximized, different experiences of this practice must be considered. PMID:24883161
Psychiatric profile of the noncompliant geriatric patient in the community.
Wolf-Klein, G P; Levy, A P; Silverstone, F A; Smith, H; Papain, P; Foley, C J
A pharmacist collected data in an active geriatric outpatient program on 140 patients admitted consecutively over a 1-year period. Compliance was monitored by patient statement, pill counting, and daily written record-keeping of all medications with the help of a pocket diary provided in the program. Weekly pharmacist counseling sessions were then initiated for all patients. After four compliance sessions, two subgroups of patients were identified: 120 compliant patients and 20 patients showing persistent 50% noncompliance. Patients were interviewed by a psychiatrist to develop a profile of the noncompliant patient. This profile may be useful in identifying other noncompliant geriatric patients. Early recognition of this special group of patients in need of directed counseling may help reduce medical misjudgment in prescribing for the frail elderly population. PMID:2491144
How to optimize patients for geriatric fracture surgery
D. Marsland; P. L. Colvin; S. C. Mears; S. L. Kates
Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture\\u000a surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve\\u000a than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high.\\u000a Multidisciplinary care, including early orthogeriatric input,
Joseph W. Savery
TirLawyn was founded in 1983 by a consortium of organizations offering health care services and\\/or education in the Philadelphia area. An Academic Geriatric Center, TirLawyn builds upon the teaching nursing home concept. It was designed at its' inception to provide interdisciplinary settings for health care students and practitioners to learn about and research aging and health care services, and to
Undiagnosed malnutrition and nutrition-related problems in geriatric patients
Dorothee Volkert; C. Saeglitz; H. Gueldenzoph; C. C. Sieber; P. Stehle
Background & aims Malnutrition is common in geriatric patients and associated with poor outcome. If recognised, effective treatment is possible.\\u000a In recent years, low nutritional awareness among health care professionals (HCPs) has been deplored with respect to the general\\u000a hospital population. The aim of the present cross-sectional study was to assess to which extent malnutrition and nutrition-related\\u000a problems are documented by
Undiagnosed malnutrition and nutrition-related problems in geriatric patients
Dorothee Volkert; C. Saeglitz; H. Gueldenzoph; C. C. Sieber; P. Stehle
Background & aims Malnutrition is common in geriatric patients and associated with poor outcome. If recognised, effective treatment is possible.\\u000a In recent years, low nutritional awareness among health care professionals (HCPs) has been deplored with respect to the general\\u000a hospital population. The aim of the present cross-sectional study was to assess to which extent malnutrition and nutrition-related\\u000a problems are documented by
End-of-life care of the geriatric surgical patient.
Peschman, Jacob; Brasel, Karen J
Providing end-of-life care is a necessity for nearly all health care providers and especially those in surgical fields. Most surgical practices will involve caring for geriatric patients and those with life-threatening or terminal illnesses where discussions about end-of-life decision making and goals of care are essential. Understanding the differences between do not resuscitate (DNR), palliative care, hospice care, and symptom management in patients at the end of life is a critical skill set. PMID:25459551
Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training.
Maggiore, Ronald J; Gorawara-Bhat, Rita; Levine, Stacie K; Dale, William
The aging of the U.S. population continues to highlight emerging issues in providing care generally for older adults and specifically for older adults with cancer. The majority of patients with cancer in the U.S. are currently 65 years of age or older; therefore, training and research in geriatrics and geriatric oncology are viewed to be integral in meeting the needs of this vulnerable population. Yet, the ways to develop and integrate best geriatrics training within the context of hematology/oncology fellowship remain unclear. Toward this end, the current study seeks to evaluate the prior and current geriatric experiences and perspectives of hematology/oncology fellows. To gain insight into these experiences, focus groups of hematology/oncology fellows were conducted. Emergent themes included: 1) perceived lack of formal geriatric oncology didactics among fellows; 2) a considerable amount of variability exists in pre-fellowship geriatric experiences; 3) shared desire to participate in a geriatric oncology-based clinic; 4) differences across training levels in confidence in managing older adults with cancer; and 5) identification of specific criteria on how best to approach older adults with cancer in a particular clinical scenario. The present findings will help guide future studies in evaluating geriatrics among hematology/oncology fellows across institutions. They will also have implications in the development of geriatrics curricula and competencies specific to hematology/oncology training. PMID:24484724
Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education
Sricharoen, Pungkava; Yuksen, Chaiyaporn; Sittichanbuncha, Yuwares; Sawanyawisuth, Kittisak
Background There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM) focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Methods Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. Results During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74%) were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001). The top three highest average satisfaction scores in the new EM curriculum group were trauma workshop, bedside teaching, and emergency medical services workshop. The mean (standard deviation) satisfaction scores of those three teaching methods were 4.70 (0.50), 4.63 (0.58), and 4.60 (0.55), respectively. Conclusion Teaching EM with workshops improved student satisfaction in EM education for medical students. PMID:25674034
Food intakes and preferences of hospitalised geriatric patients
Shahar, Suzana; Chee, Kan Yin; Wan Chik, Wan Chak Pa'
Background A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. Methods Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors affecting dietary adequacy were also investigated. Results The findings indicated that the mean intakes of energy and all nutrients investigated except for vitamin C and fluid were below the individual requirement for energy, protein and fluid, and the Malaysian Recommendation of Dietary Allowances (RDA) for calcium, iron, vitamin A, thiamin, riboflavin, niacin and acid ascorbic. In general, subjects preferred vegetables, fruits and beans to red meat, milk and dairy products. There was a trend of women to have a higher percentage for food wastage. Females, diabetic patients, subjects who did not take snacks and subjects who were taking hospital food only, were more likely to consume an inadequate diet (p < 0.05 for all values). Conclusions Food service system in hospital should consider the food preferences among geriatric patients in order to improve the nutrient intake. In addition, the preparation of food most likely to be rejected such as meat, milk and dairy products need some improvements to increase the acceptance of these foods among geriatric patients. This is important because these foods are good sources of energy, protein and micronutrients that can promote recovery from disease or illness. PMID:12165100
Research priorities in geriatric oncology for 2013 and beyond
Mohile, Supriya; Dale, William; Magnuson, Allison; Kamath, Nayana; Hurria, Arti
The incidence of cancer increases with advanced age. Unfortunately, there is a significant lack of evidence regarding the safety and efficacy of treatments. The oncology community also lacks information regarding which older patients are most likely to benefit from treatment without undue toxicities. Interventions to lower symptoms and reduce long-term complications from cancer and cancer treatment in older patients are urgently needed. Establishing research priorities in geriatric oncology could help guide researchers and focus efforts on interventions that have the highest likelihood of improving outcomes. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and National Cancer Institute, held linked conferences as part of a U13 grant in September of 2010 and November of 2012, summarising the gaps in knowledge in geriatric oncology and recommending ways to close these gaps. The overall purpose of this review is to highlight the important research priorities in geriatric oncology from the literature and from the previous U13 meetings. More evidence regarding the treatment of older cancer patients is urgently needed given the rapid aging of the population. PMID:25346565
A practical approach to geriatric assessment in oncology.
Rodin, Miriam B; Mohile, Supriya G
More than half of new cancers are diagnosed in elderly patients, but data from randomized clinical trials do not represent the elderly population. Comprehensive geriatric assessment (CGA) can contribute valuable information to oncologists for risk stratification of elderly cancer patients. Functional impairments, frailty markers, cognitive impairments, and physical disabilities increase the risk for adverse outcomes during cancer treatment. Evidence is accumulating that selected elderly cancer patients benefit from CGA and geriatric interventions. However, perceived barriers to CGA include time, familiarity, cost, and lack of a well-defined procedure to interpret and apply the information. We present a model for rapid selection of elderly who would benefit from CGA using screening tools such as the Vulnerable Elders-13 Survey. We also define important geriatric functional risk factors, including mobility limitation, frailty, and dementia, and demonstrate how brief screening tests can make use of data realistically available to clinical oncologists to determine a stage of aging. Summary tables and a decision tree demonstrate how these data can be compiled to determine the risk for toxicities and to anticipate ancillary support needs. PMID:17488994
Research priorities in geriatric oncology for 2013 and beyond.
Mohile, Supriya; Dale, William; Magnuson, Allison; Kamath, Nayana; Hurria, Arti
The incidence of cancer increases with advanced age. Unfortunately, there is a significant lack of evidence regarding the safety and efficacy of treatments. The oncology community also lacks information regarding which older patients are most likely to benefit from treatment without undue toxicities. Interventions to lower symptoms and reduce long-term complications from cancer and cancer treatment in older patients are urgently needed. Establishing research priorities in geriatric oncology could help guide researchers and focus efforts on interventions that have the highest likelihood of improving outcomes. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and National Cancer Institute, held linked conferences as part of a U13 grant in September of 2010 and November of 2012, summarising the gaps in knowledge in geriatric oncology and recommending ways to close these gaps. The overall purpose of this review is to highlight the important research priorities in geriatric oncology from the literature and from the previous U13 meetings. More evidence regarding the treatment of older cancer patients is urgently needed given the rapid aging of the population. PMID:25346565
How to implement a geriatric assessment in your clinical practice.
Sattar, Schroder; Alibhai, Shabbir M H; Wildiers, Hans; Puts, Martine T E
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA. PMID:25187477
Geriatric considerations in the treatment of advanced prostate cancer
Kessler, Elizabeth R.
Prostate cancer is the most common non-cutaneous cancer in US men and mainly affects elderly patients, with most new diagnoses occurring in those over 65. As the geriatric population in the US continues to grow, the incidence of this disease is likewise expected to rise. Many older patients are diagnosed with advanced disease or are treated only when their disease becomes symptomatic or metastatic. The treatment options for advanced prostate cancer have increased dramatically in the last decade. It is important to understand the nuances of caring for an elderly cancer patient in order to optimally treat prostate cancer, such as the importance of using a geriatric assessment to uncover overlooked or under-reported vulnerabilities. In addition, many of the newly approved agents for the treatment of advanced prostate cancer have a unique mechanism of action and toxicities that warrant consideration when choosing therapies for older patients. This review focuses on the importance of a geriatric assessment as well as the considerations of treating elderly patients with the newer agents approved for prostate cancer. PMID:24860655
Integrating and Evaluating Geriatrics in Medical School: A Novel Approach for the Challenge
ERIC Educational Resources Information Center
Besdine, Richard W.; Shield, Renee R.; McNicoll, Lynn; Campbell, Susan E.; Wetle, Terrie
Brown Medical School developed a comprehensive curriculum in which enriched aging content increased from 22 to 80 hours in preclerkship courses and was also added for clerkships, residencies, and nongeriatrician physicians. Innovative evaluation strategies are also described. Highlights include "treasure hunts" in the anatomy laboratory, a…
Nurses Improving Care for Healthsystem Elders – a model for optimising the geriatric nursing practice environment
Capezuti, Elizabeth; Boltz, Marie; Cline, Daniel; Dickson, Victoria Vaughn; Rosenberg, Marie-Claire; Wagner, Laura; Shuluk, Joseph; Nigolian, Cindy
Aims and objectives To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses' perception of their practice and its' relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs Discursive paper. Method In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals' systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff's perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults. PMID:23083387
Standardization of Course Plan and Design of Objective Structured Field Examination (OSFE) for the Assessment of Pharm.D. Student's Community Pharmacy Clerkship Skills
Monajjemzadeh, Farnaz; Shokri, Javad; Mohajel Nayebi, Ali Reza; Nemati, Mahboob; Azarmi, Yadollah; Charkhpour, Mohammad; Najafi, Moslem
Purpose: This study was aimed to design Objective Structured Field Examination (OSFE) and also standardize the course plan of community pharmacy clerkship at Pharmacy Faculty of Tabriz University of Medical Sciences (Iran). Methods: The study was composed of several stages including; evaluation of the old program, standardization and implementation of the new course plan, design and implementation of OSFE, and finally results evaluation. Results: Lack of a fair final assessment protocol and proper organized educating system in various fields of community pharmacy clerkship skills were assigned as the main weaknesses of the old program. Educational priorities were determined and student's feedback was assessed to design the new curriculum consisting of sessions to fulfill a 60-hour training course. More than 70% of the students were satisfied and successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05). In addition, they believed that OSFE was a suitable testing method. Conclusion: The defined course plan was successfully improved different skills of the students and OSFE was concluded as a proper performance based assessment method. This is easily adoptable by pharmacy faculties to improve the educational outcomes of the clerkship course. PMID:24511477
The Differential Impact of Clerk Interest and Participation in a Child and Adolescent Psychiatry Clerkship Rotation upon Psychiatry and Pediatrics Residency Matches
ERIC Educational Resources Information Center
Hanson, Mark D.; Szatmari, Peter; Eva, Kevin W.
Objective: The authors evaluated the differential impact of clerk interest and participation in a Child and Adolescent Psychiatry (CAP) clerkship rotation upon psychiatry and pediatrics residency matches. Method: Authors studied clerks from the McMaster University M.D. program graduating years of 2005-2007. Participants were categorized as 1)…
How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes toward Geriatric Care
ERIC Educational Resources Information Center
de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.
Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the…
California Geriatric Education Center Logic Model: An Evaluation and Communication Tool
ERIC Educational Resources Information Center
Price, Rachel M.; Alkema, Gretchen E.; Frank, Janet C.
A logic model is a communications tool that graphically represents a program's resources, activities, priority target audiences for change, and the anticipated outcomes. This article describes the logic model development process undertaken by the California Geriatric Education Center in spring 2008. The CGEC is one of 48 Geriatric Education…
A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients
Background: the usefulness of geriatric evaluation and management (GEM) approaches in the care of frail elderly patients remains uncertain. We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system. Methods: we conducted a randomised trial with 345 patients from five centres. Ninety additional patients from four separ- ate centres without GEM
Georgia Sassen
Any discussion of developing and evaluating geriatrics training sites must focus primarily on sites such as teaching nursing homes, in which heretofore unavailable clinical settings become teaching settings for clinicians, and on changes that can be made in hospital?based training so that geriatrics is better taught. Another important area of training is harder to find in action, and is therefore
Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients
ERIC Educational Resources Information Center
Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert
Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…
The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center
ERIC Educational Resources Information Center
Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia
In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…
Medical students' recognition and application of geriatrics principles in a new curriculum.
Nanda, Aman; Farrell, Timothy W; Shield, Renée R; Tomas, Maria; Campbell, Susan E; Wetle, Terrie
Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles. PMID:23379444
Baycrest Centre for Geriatric Care Patients with Severe Memory Loss Given Brighter Future with
Toronto, University of
One Handhelds Since 1918, Baycrest Centre for Geriatric Care has been devoted to enriching the quality of lifeBaycrest Centre for Geriatric Care Patients with Severe Memory Loss Given Brighter Future with palm joined Baycrest's ground- breaking amnesia rehabilitation efforts to apply emerging handheld technology
Mortality of Geriatric and Younger Patients with Schizophrenia in the Community
ERIC Educational Resources Information Center
Ran, Mao-Sheng; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Li, Li; Li, Si-Gan; Mao, Wen-Jun; Hu, Shi-Hui; Schwab, Gerhard; Conwell, Yeates
Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age greater than or equal to 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a…
Geriatric Oncology: How Far Have We Gone and What Are the Next Steps?
Jean-Emmanuel Kurtz; Damien Heitz; Valérie Kurtz-Illig; Patrick Dufour
Geriatric oncology is increasingly developing in Western countries as it is established that cancer peaks after 60 years of age, and the populations are inexorably aging. Aging is associated with a decrease in the use of chemotherapy, and some patients are therefore exposed to undertreatment. Comprehensive geriatric assessment is a composite of several scores that target the multidimensional aspects of
An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China
ERIC Educational Resources Information Center
Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping
A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized…
The Development of Geriatric Curricula in U.S. Dental Schools, 1979-1984.
ERIC Educational Resources Information Center
Beck, James D.; Ettinger, Ronald L.
A 1984 survey of dental schools was compared with a 1979 survey showing an increase in the teaching of geriatric dentistry. Factors associated with the establishment of a course were that the school was located in a state with a large geriatric population and financial assistance for patients was available. (Author/MLW)
Integrating Structured Learning and Scholarly Activities into Clerkship Rotations: A Win–Win for Students and Preceptors
Miller, Stephannie; Fulton, Judith; Mostow, Eliot
Objective: To merge scholarly activity into the curriculum developed for medical students electing a rotation in wound care and/or dermatology. Approach: The authors adapted the unique wound care curriculum developed for medical student rotators and residents to incorporate structured scholarly projects, opportunities for mentorship, and feedback for continued improvement. Results: Benefits have been observed to both students and to the clinic, as reflected by online survey results, increased productivity in the form of posters and manuscripts, and opportunities for professional networking. Discussion: Rotations and clerkships can be transformed from haphazard, bystander observational experiences to active participation that enhances comprehension and retention, while also providing benefits to preceptors. Innovation: Integration between research, education, and clinical activities in a structured way can provide opportunity for enhanced learning experiences and promote the concept of evidence-based practice. Conclusion: With observed benefits to students, researchers, and staff in this clinical setting, other clerkship rotation settings should consider an integrated and structured approach to learning, which includes scholarly activities. Further rigorous program evaluation is necessary to further quantify preliminary positive feedback regarding this approach. PMID:24804160
[Practical guideline for nutritional care in geriatric institutions].
Volkert, D
Malnutrition is widespread in geriatric patients, but often unrecognized and untreated. The main barriers against implementation of adequate nutritional care are seen in low nutritional awareness, lack of knowledge, interest and responsibilities but also in established procedures and lack of standard protocols for nutritional screening and therapy. It is, thus, the aim of the present publication to provide a comprehensive, practice oriented guideline for quality assurance of nutritional care of elderly people in geriatric institutions. The guideline includes routine assessment of individual nutritional status as well as the planning and implementation of appropriate interventions and measurement of results. The guideline is aimed at the prevention and adequate treatment of weight loss and malnutrition and is composed of the following sections: 1) screening, 2) assessment, 3) definition of aims, 4) intervention, 5) monitoring with adaptation of aims and interventions, 6) planning of nutritional care after discharge. Appropriate interventions aim, on the one hand, at the elimination of underlying causes of malnutrition and, on the other hand, at adequate and sufficient dietary intake to meet the requirements. Dietetic, nursing and medical actions should be implemented in a coordinated manner in order to use all options to achieve the best nutritional care for each patient. As a prerequisite for high quality individual nutritional care, several basic conditions have to be established, e.g. appropriate supply of food and beverages to meet patient needs, well-organized caring processes during meals, willingness of all involved persons for interdisciplinary teamwork, and well-regulated responsibilities. This general guideline has to be adapted to the local conditions of each institution and consistently put into practice. For implementation of the guideline, a nutrition team with members of all relevant professions should be organized with regular meetings. In the long run, increasing nutritional awareness and established routines for adequate nutritional screening and therapy will enable high quality nutritional care of geriatric patients with manageable charges. PMID:18398632
Yogic practice and diabetes mellitus in geriatric patients
Beena, Rani K; Sreekumaran, E
Background: Stress has negative effect on health and type 2 diabetes patients may be at an increased risk. Abnormally high levels of free radicals and the simultaneous decline of antioxidant defense mechanisms can increase lipid peroxidation and insulin resistance. The objective of the present study was to demonstrate the efficacy of yogic practice in geriatric patients with type 2 diabetes mellitus and also to compare the efficacy with the state of glycaemic control. Materials and Methods: Seventy three (73) healthy elderly patients of type 2 diabetes mellitus in the age group of 60 to 70 years with a history of diabetes for 5 to 10 years and with poor glycaemic control (HbA1c >8 %) residing in Kozhikode district were recruited for the study. The subjects were divided into three groups according to their glycaemic control. Group I with HbA1c 8.6–9.7 %, group II with HbA1c 9.8–10.7 % and group III with HbA1c 10.8–12.7 %. Participants did yogic practice under the supervision of experienced trainer, daily 90 minutes and for three months. Biochemical estimation of HbA1c, glucose, lipid profile, cortisol, ferritin, malondialdehyde (MDA) and catalase activity were carried out on 0 day and 90th day. Seventy patients participated in a comparable control session. Results: The participants in the test group showed statistically significant (P < 0.001) decrease in glucose, HbA1c, lipids, cortisol, ferritin, MDA and significant increase in catalase activity after yogic practice. Conclusions: Yoga may improve risk profiles induced by stress in geriatric patients with type 2 diabetes and may have promise for the prevention or delay in diabetes complications. And at all stages of the disease a significant improvement can be achieved by yogic practice in geriatric diabetes. PMID:23440675
An autonomy supportive model of geriatric team function.
Powers, J S; White, S; Varnell, L; Turvy, C; Kidd, K; Harrell, D; Knight, B; Floyd, K; Zupko, K
Interdisciplinary teams play a critical role in the delivery of geriatric health care. Health care professionals are commonly left to develop teamwork skills by chance. Medical team function differs from traditional group theory in that all members are caregivers. A non-competitive supportive atmosphere is appropriate for patient care. We propose a participatory (autonomy supportive) model fostering self-realization and positive reinforcement as an organizing philosophy. The primary group task is to maximize patient functional independence and personal goals. Leadership is task-dependent. PMID:10943147
Health care: economic impact of caring for geriatric patients.
Rich, Preston B; Adams, Sasha D
National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. PMID:25459539
Short-term geriatric assessment units: 30 years later
Background The increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele. Established progressively over the last 30 years, the short-term Geriatric Assessment Unit (GAU) is a specialized care program, now implemented in all the general hospital centres in Quebec. Within the scope of a broader reflection upon the appropriate care delivery for elderly patients in our demographic context, there is a need to revisit the role of GAU within the hospital and the continuum of care. The objective of this project is to describe the range of activities offered by Quebec GAU and the resources available to them. Methods In 2004, 64 managers of 71 GAU answered a mail questionnaire which included 119 items covering their unit's operation and resources in 2002-2003. The clinical and administrative characteristics of the clientele admitted during this period were obtained from the provincial database Med-Echo. The results were presented according to the geographical location of GAU, their size, their university academic affiliation, the composition of their medical staff, and their clinical care profile. Results Overall, GAU programs admitted 9% of all patients aged 65 years and older in the surveyed year. GAU patients presented one or more geriatric syndromes, including dementia. Based on their clientele, three distinct clinical care profiles of GAU were identified. Only 19% of GAU were focused on geriatric assessment and acute care management; 23% mainly offered rehabilitation care, and the others offered a mix of both types. Thus, there was a significant heterogeneity in GAU's operation. Conclusions The GAU is at the cutting edge of geriatric services in hospital centres. Given the scarcity of these resources, it would be appropriate to better target the clientele that may benefit from them. Standardizing and promoting GAU's primary role in acute care must be reinforced. In order to meet the needs of the frail elderly not admitted in GAU, alternative care models centered on prevention of functional decline must be applied throughout all hospital wards. PMID:20569433
Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012
The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/or liability for any errors and/or omissions in any abstract as published.
"Pedogeriatrics": a pediatric nephrologist's outlook on common challenges facing pediatric and geriatric nephrologists.
Grünberg, Jose
Dramatic demographic changes longevity and medical progress helped create a new population made up of the survivors of previously fatal diseases. These trends pose new major social and economic challenges that should be accounted for in health policy making. This paper discusses the similarities between the specialties of pediatrics and geriatrics, especially in the realm of patient care. Children and the elderly share a limited autonomy and dependence on the human environment (i.e., willing and able caregiving persons) due to age or disease. The long-term care of dependent patients (DP) requires caregiving persons who share with dependent persons the risk of losing autonomy, facing burnout, family disruption, and interference with work and educational activities. Families with DPs may face potential losses of income because both patients and caregivers are partially or completely unable to work, the former for medical reasons and the latter due to the new demands on their time and energy. Additionally, new expenses have to be met because while direct medical expenses might be covered by insurance or the State, other expenses have to be financed by the family, such as co-payments for medicines, new water or electricity home installations, and transport and eventual hotel costs if they have to stay overnight near a hospital outside of their town. The main objectives of long-term care should be to maximize patients' independence and prevent their physical and psychological deterioration while minimizing the social, economic and personal costs to caregivers. To achieve these goals, one needs a holistic approach, a multidisciplinary professional team (doctors, nurses, social workers, nutritionists and psychologists) and auxiliary staff (secretaries, electricians, administrators, messengers, cleaning staff, doormen, nursing aids and coordinators of medical appointments and medical procedures). Optimal management of DPs on chronic treatments such as chronic dialysis requires adequate communication skills, respectful attitudes toward patients and caregivers and effective use of communication and information technologies. Auxiliary personnel require specific training to contribute effectively to the DP attention processes. This paper postulates that pediatric and geriatric teams and their patients would benefit from closer training and sharing of experiences and systems. PMID:19517264
American geriatrics society care of lesbian, gay, bisexual, and transgender older adults position statement: american geriatrics society ethics committee.
There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high-quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need. PMID:25803784
[Geriatric nursing staff retention. Opportunities, potentials, and strategies].
Joost, A
Retaining geriatric nurses in their line of work could be an important strategy to prevent the shortage of skilled staff in the future. A prerequisite for this is detailed knowledge of the length and structure of professional careers. The IWAK ( Institut für Wirtschaft, Arbeit und Kultur) evaluated data from the German Social Insurance and carried out a structural analysis of the professional careers of geriatric nurses. Results showed that the average duration of professional careers is 20 years, of which 11.7 years constitute the period of employment and 7.8 years account for periods of inactivity. According to these findings, there is a considerable potential in extending professional careers and reducing the periods of inactivity to make better use of the existing skilled staff and to reduce staff shortage in this area. Concrete measures could involve improvement of working conditions (with the aim of avoiding long periods of inactivity and illness-related premature career endings as well as of increasing job satisfaction), creating better conditions for a good balance between work and family life, as well as setting up individual strategies to expand weekly working hours. Key players are businesses but also local authorities and politicians. PMID:23884527
Clinical preference for factors in treatment of geriatric depression
Riepe, Matthias W
Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. PMID:25565848
FKBP5 Polymorphisms and Antidepressant Response in Geriatric Depression
Sarginson, Jane E.; Lazzeroni, Laura C.; Ryan, Heather S.; Schatzberg, Alan F.; Murphy, Greer M.
Genetic variation at the FKBP5 locus has been reported to affect clinical outcomes in patients treated with antidepressant medications in several studies. However, other reports have not confirmed this association. FKBP5 may regulate the sensitivity of the hypothalamic–pituitary–adrenal axis. We tested two FKBP5 single nucleotide polymorphisms (rs1360780 and rs3800373) in a sample of 246 geriatric patients treated for 8 weeks in a double-blind randomized comparison trial of paroxetine and mirtazapine. These two polymorphisms had previously been reported to predict efficacy in depressed patients treated with selective serotonin reuptake inhibitors such as paroxetine, and those treated with mirtazapine, an agent with both serotonergic and noradrenergic actions. However, we found no significant associations between these FKBP5 genetic variants and clinical outcomes. Neither mean Hamilton Depression Rating Scale scores nor time to remission or response were predicted by FKBP5 genetic variation. These results suggest that FKBP5 is unlikely to play a major role in determining antidepressant treatment outcomes in geriatric patients. PMID:19676097
FKBP5 polymorphisms and antidepressant response in geriatric depression.
Sarginson, Jane E; Lazzeroni, Laura C; Ryan, Heather S; Schatzberg, Alan F; Murphy, Greer M
Genetic variation at the FKBP5 locus has been reported to affect clinical outcomes in patients treated with antidepressant medications in several studies. However, other reports have not confirmed this association. FKBP5 may regulate the sensitivity of the hypothalamic-pituitary-adrenal axis. We tested two FKBP5 single nucleotide polymorphisms (rs1360780 and rs3800373) in a sample of 246 geriatric patients treated for 8 weeks in a double-blind randomized comparison trial of paroxetine and mirtazapine. These two polymorphisms had previously been reported to predict efficacy in depressed patients treated with selective serotonin reuptake inhibitors such as paroxetine, and those treated with mirtazapine, an agent with both serotonergic and noradrenergic actions. However, we found no significant associations between these FKBP5 genetic variants and clinical outcomes. Neither mean Hamilton Depression Rating Scale scores nor time to remission or response were predicted by FKBP5 genetic variation. These results suggest that FKBP5 is unlikely to play a major role in determining antidepressant treatment outcomes in geriatric patients. PMID:19676097
Geriatric Workforce Capacity: A Pending Crisis for Nursing Home Residents
Lee, Wei-Chen; Sumaya, Ciro V.
Introduction: The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. Methods: This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. Results: English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings. PMID:24350193
Endovascular abdominal aortic aneurysm repair in the geriatric population
Saratzis, Athanasios; Mohamed, Saif
Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date. PMID:23097659
Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review
Keijsers, Carolina J P W; van Hensbergen, Larissa; Jacobs, Lotte; Brouwers, Jacobus R B J; de Wildt, Dick J; ten Cate, Olle Th J; Jansen, Paul A F
AIMS Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms 'pharmacology' and 'education' in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1–935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given. PMID:22416832
ERIC Educational Resources Information Center
Badawi, Ramsey D.
Describes the use of nuclear medicine techniques in diagnosis and therapy. Describes instrumentation in diagnostic nuclear medicine and predicts future trends in nuclear medicine imaging technology. (Author/MM)
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The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.
Filinson, Rachel; Clark, Phillip G; Evans, Joann; Padula, Cynthia; Willey, Cynthia
In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics. PMID:22816974
Griffiths, Matt
Medication errors are the second most reported incident type in the NHS. Other concerns around medicines management include poor medicines security, theft and poor administration practice. PMID:25758502
Social Medicine Molecular Preventive Medicine --------------------------------------------------------------------
Miyashita, Yasushi
28 Social Medicine Molecular Preventive Medicine research will contribute to Molecular Preventive Medicine. ·Pathogenesis of diseases by chemokine ------------------------------------------------------------------------------------------------ http://publichealth.m.u-tokyo.ac.jp/ Public health is the science and art of preventing disease
Geriatric Nursing Resources for Care of Older Adults: Assessment Tools
NSDL National Science Digital Library
For nurses interested in keeping up to date with developments in geriatric treatment, this set of resources created by expert practitioners will be quite a find. The entire site was developed as part of the Nurse Competence in Aging initiative created by the American Nurses Association. Here, visitors can read over twenty-five two-page assessment tools that include such helpful titles as â??Assessing Nutrition in Older Adultsâ?ť, â??Predicting Pressure Ulcer Riskâ?ť, and â??Immunizations for the Older Adultâ?ť. Written in clear and direct language, these resources will also be of assistance for nursing educators and those who are responsible for professional development workshops. It is also worth mentioning that these short tools are designed as screening tools, and are not for diagnosis.
Actualizing a mobile integrated system for geriatric care.
Chew, Han Ei; Faber, Johannes; Liu, Zhiming; Madera, Vanessa; Qamar, Nafees
Population aging looms over countries all over the world. The social and economic implications of this phenomenon extend beyond the individual person and the immediate family, affecting broader society and the global community in profound ways. Aging populations increase pressure on already over-burdened public health care services and expenditures. To address this impending predicament, many health care providers and countries have turned to technological solutions. The near-ubiquity of mobile devices entails that mHealth will rapidly become a key component of technologically-enabled health care delivery services. This poster presents research and engineering challenges for a sustainable ICT solution that supports information exchange for mobile geriatric care. PMID:23920883
Report on the 14th conference of the international society of geriatric oncology.
Wedding, Ulrich
14th Conference of the International Society of Geriatric Oncology, Lisbon, Portugal, 23-25 October 2014 The annual international conference of the International Society of Geriatric Oncology gathered about 400 scientists in Lisbon in October 2014. Arti Hurria, President of the Society, opened the meeting and presented recent Globocan data on the development of the number of people newly diagnosed with cancer. From 2012 to the expected figures of 2035 the number of people aged 65 years and older diagnosed with cancer will increase by 108%. All areas of the world are concerned, not only the so called western Countries. Five major tracts covered important areas in the field of Geriatric Oncology: solid tumors; hematological malignancies; new therapies and basic science; nursing, supportive care and geriatric assessment; advocacy and social-economical issues. PMID:25760969
Guide to Geriatric Syndromes: Common and Often Related Medical Conditions in Older Adults
... Print Share Glossary previous page Related Topics Cataracts Delirium Dementia Fainting (Syncope) Falls Prevention Geriatrics Glaucoma Macular ... an overactive bladder muscle, urinary tract infection, constipation, delirium, heart disease, diabetes, dementia, medication side effects, and ...
Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.
Rolland, Yves; Resnick, Barbara; Katz, Paul R; Little, Milta O; Ouslander, Joseph G; Bonner, Alice; Geary, Carol R; Schumacher, Karen L; Thompson, Sarah; Martin, Finbarr C; Wilbers, Joachim; Zúńiga, Franziska; Ausserhofer, D; Schwendimann, R; Schüssler, S; Dassen, Theo; Lohrmann, Christa; Levy, Cari; Whitfield, Emily; de Souto Barreto, Philipe; Etherton-Beer, Christopher; Dilles, Tinne; Azermai, Majda; Bourgeois, Jolyce; Orrell, Martin; Grossberg, George T; Kergoat, Hélčne; Thomas, David R; Visschedijk, Jan; Taylor, Stephanie J C; Handajani, Yvonne S; Widjaja, Nelly T; Turana, Yuda; Rantz, Marilyn J; Skubic, Marjorie; Morley, John E
The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. PMID:24767432
Working group recommendations: research on content and efficacy of geriatric evaluation and management interventions.
Jahnigen, D W; Applegate, W B; Cohen, H J; Epstein, A; Granger, C; Hogan, D; Kennedy, R; Lazaroff, A
Methods of conducting comprehensive geriatric evaluation and management (GEM) are proliferating in a variety of clinical settings. However, rigorous evaluations of efficacy for this new approach to care of older patients have demonstrated a favorable impact on patient outcome in only a few studies. All of these have been controlled single site studies, and replication is needed. If replication studies show similar results, further studies should be undertaken to define the minimum necessary intervention to achieve the desired outcome. Controlled trials are needed to determine if consultative geriatric evaluation and/or primary patient management is effective. Further innovative work is needed in model development for geriatric assessment and management in outpatient settings. Finally, studies of geriatric evaluation and management in other environments, such as home care or the nursing home, are recommended. PMID:1885877
Predictors of favorable outcome in elderly stroke patients two years after discharge from geriatric rehabilitation
W. Meins; H.-P. Meier-Baumgartner; D. Neetz; W. von Renteln-Kruse
Summary This study was done to determine the independent predictors of long-term survival and long-term functional outcome in geriatric\\u000a stroke patients with a high level of co-morbidity. We prospectively recruited 302 consecutive patients transferred from local\\u000a hospitals of acute care to inpatient geriatric rehabilitation with a median of 23 days after stroke. The cohort with a mean\\u000a age of 75.1
Risks and suggestions to prevent falls in geriatric rehabilitation: a participatory approach
Edgar Ramos Vieira; Colleen Berean; Debra Paches; Larissa Costa; Natacha Décombas-Deschamps; Penny Caveny; Doris Yuen; Lauralee Ballash
ObjectiveThe objective of this study was to establish the rates and to gather information from patients, staff and family members on risks and potential measures to prevent patient falls on geriatric rehabilitation units in a hospital.MethodsThe falls recorded in the geriatric rehabilitation units between January 2006 and December 2008 were reviewed to establish their rates (falls\\/1000 patient days) and locations.
Loss of olfactory function and nutritional status in vital older adults and geriatric patients.
Toussaint, Nicole; de Roon, Margot; van Campen, Jos P C M; Kremer, Stefanie; Boesveldt, Sanne
The aim of this cross-sectional study was to assess the association of olfactory function and nutritional status in vital older adults and geriatric patients. Three hundred forty-five vital (mean age 67.1 years) and 138 geriatric older adults (mean age 80.9 years) were included. Nutritional status was assessed using the mini nutritional assessment-short form. The Sniffin' Sticks was used to measure olfactory function. Eleven percentage of the vital older adults were at risk of malnutrition, whereas 60% of the geriatric participants were malnourished or at risk. Only 2% of the vital older adults were anosmic, compared with 46% of the geriatric participants. Linear regression demonstrated a significant association (P = 0.015) between olfactory function and nutritional status in the geriatric subjects. However, this association became insignificant after adjustment for confounders. Both crude and adjusted analysis in the vital older adults did not show a significant association. The results indicate that, in both groups of elderly, there is no direct relation between olfactory function and nutritional status. We suggest that a decline in olfactory function may still be considered as one of the risk-factors for malnutrition in geriatric patients-once co-occurring with other mental and/or physical problems that are more likely to occur in those patients experience. PMID:25680372
Kenneth L. Minaker, MD, FRCP(C), Chief, Geriatric Medicine Unit
Mootha, Vamsi K.
for morbidity CHF after non-cardiac surgery Stroke after coronary surgery 50% of surgical emergencies and 75% of postoperative deaths occur in the elderly #12;ASA Classification for Elderly Patients -Emergency OperationE 100 Sx and Sympt and exercise capacity Drugs: Tobacco, alcohol, Rx and OTC Allergies Genetics: malignant
Kenneth L. Minaker, MD, FRCP(C), CSC(GM) Chief, Geriatric Medicine Unit
Mootha, Vamsi K.
-20%  They are also healthier · Activates and conserves regulatory genetic pathways SIRT-1 · Activates SIRTUINS restriction pathways 8. Brain insulin (longevity regulated by insulin signaling in particular neurons in brain
Mindfulness: Reconnecting the Body and Mind in Geriatric Medicine and Gerontology
ERIC Educational Resources Information Center
Rejeski, W. Jack
Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the…
Diabetes means your blood glucose, or blood sugar, levels are too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends ...
Developing Leadership in Geriatric Education. Proceedings of the Annual Summer Geriatric Institute (5th, Lexington, Kentucky, July 23-25, 1990).
ERIC Educational Resources Information Center
Gardner, Davis L., Ed.; Patzwald, Gari-Anne, Ed.
Papers in these proceedings are organized into four sections: (1) Research Studies in Aging; (2) Innovative Approaches in Geriatric Education; (3) Faculty Development Models; and (4) "The Publication Process: Perils and Pearls" (Workshop). Clinical Experiences: Design Not Chance" (Matzo); "The Development of a Collaborative Gerontological Research…
competency Course Objective 1 1a Apply evidence based knowledge to diagnosis and treatment questions in ambulatory and geriatric patient care.
Myers, Lawrence C.
knowledge to diagnosis and treatment questions in ambulatory and geriatric patient and treatment question in ambulatory and geriatric patient care. 3 1e Apply current knowledge of disease prevention, risk factor modification, end-of-life care and quality improvement
ERIC Educational Resources Information Center
Beiswenger, James N., Ed.; Jeanotte, Holly, Ed.
Described as a survival manual for Indian women in medicine, this collected work contains diverse pieces offering inspiration and practical advice for Indian women pursuing or considering careers in medicine. Introductory material includes two legends symbolizing the Medicine or Spirit Woman's role in Indian culture and an overview of Indians Into…
Osteopathic Medicine: About Osteopathic Medicine
... Advancing the distinctive philosophy and practice of osteopathic medicine Inside the AOA About the AOA AOA Annual ... DOs Licensed? How Are DOs Certified? About Osteopathic Medicine Page Content You are more than just the ...
A current perspective on geriatric lower urinary tract dysfunction
Jung, Ha Bum; Kim, Hyung Jee
Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
Geriatric Assessment in Older Patients with Breast Cancer
Klepin, Heidi; Mohile, Supriya; Hurria, Arti
Most cases of breast cancer are diagnosed in older adults. Compared with younger women, older women as a group are at increased risk for breast-cancer-specific mortality and at higher risk for treatment-associated morbidity as well. At the same time, older women are less likely to be offered preventive care or adjuvant therapy for this disease. There are major gaps in evidence regarding the optimal evaluation and treatment of older women with breast cancer due to significant under-representation in clinical trials. Chronologic age alone is an inadequate predictor of treatment tolerance and benefit in this heterogeneous population. Multiple issues uniquely associated with aging have an impact on cancer care, including functional impairment, comorbidity, social support, cognitive function, psychological state, and financial stress. Applying geriatric principles and assessment to this older adult population would inform decision-making, by providing estimates of life expectancy and identifying individuals most vulnerable to morbidity. Ongoing research is seeking to identify which assessment tools can best predict outcomes in this population, and thus guide us in tailoring treatments to maximize benefits in older adults with breast cancer. PMID:19200420
Approach to Helicobacter pylori infection in geriatric population
Cizginer, Sevdenur; Ordulu, Zehra; Kadayifci, Abdurrahman
The prevalence of Helicobacter pylori (H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal (GI) malignancies, upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore, "endoscopy and treat" strategy may be more appropriate instead of "test and treat" strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication, except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however, the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be considered before starting the treatment. This paper reviews briefly the epidemiology, diagnosis, disease manifestations, and treatment options of H. pylori in the geriatric population. PMID:25133042
Provocative dietary factors in geriatric hypertension: A surveillance study
Jagtap, Madhavi V.; Deole, Yogesh S.; Chandola, Harimohan; Ravishankar, B.
Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide being more prevalent in old age. The present survey of hypertensive patients fulfilling the standard diagnostic criteria of WHO/ISH (2004) is carried out in geriatric age group from the Saurashtra region of Gujarat in India to observe the dietary pattern and provocative factors. Total 120 patients of 50 to 80 years of age having systolic blood pressure >140 mm Hg and ?180 mm Hg and diastolic blood pressure >90 mm Hg and ?110 mm Hg irrespective of gender and religion were selected for the present study. They were interviewed for list of provocative factors enlisted in Ayurveda. As observed, the study supported the facts described in Ayurveda that dietary etiological factors, such as excess intake of Lavana (salty), Amla (sour), Katu (pungent), Tikshna, Ushna (hot), Vidahi (producing burning sensation), Viruddha (incompatible), Snigdha (unctuous), Abhishyandi (leading to obstruction), Madhura (sweet), Guru (heavy to digest) dietary articles, Ajirnashana (taking diet before complete digestion of previous meal), Adhyashana (repeated eating at short intervals), will vitiate Rakta dhatu as well as Pitta dosha in the body leading to disorders like hypertension. Hypertension in old age is found to be a disease of Vata-Pitta dominant vitiation with the involvement of Rasa, Rakta, Meda as main Dushya (vitiated factors) and dietary factors can contribute to worsening of the disease. The etiological factors having role in the pathogenesis can also be applied for preventive guidelines for the management of hypertension. PMID:23723671
In vitro biomechanical study of female geriatric cervical vertebral bodies.
Yoganandan, N; Pintar, F; Wilson, C R; Sances, A
Compressive strength tests were conducted on fresh human geriatric female cervical vertebral bodies. Nineteen specimens were compressed to 50% of their initial height using an electrohydraulic testing device. The mechanical force-deflection response was sigmoidal with continuously changing resistance. The mean cross-sectional area and bone mineral content (BMC) of the vertebral bodies progressively increased from C3 (area: 333.8 mm2, BMC: 1.56 g) to C6 (area: 499.7 mm2, BMC: 2.18 g). The maximum compressive force increased from 1060 N at C3 to 1787 N at C6. The stiffness and the energy absorbed at failure also increased from C3 to C6 (stiffness: 279.95 to 556.41 N mm-1, energy: 2.45 to 4.16 J). These parameters demonstrated a decreasing tendency from C6 to C7. The relatively higher biomechanical parameters at the sixth vertebral level compared with its caudad and cephalad counterparts may be due to the fact the transition of the cervical lordosis to thoracic kyphosis begins at this level. Furthermore, the change in the anatomy of the unicinate processes in the cervical column around this region may also be a contributing factor. PMID:2319771
Geriatric assessment in older patients with breast cancer.
Klepin, Heidi; Mohile, Supriya; Hurria, Arti
Most cases of breast cancer are diagnosed in older adults. Older women have an increased risk for breast cancer-specific mortality and are at higher risk for treatment-associated morbidity than younger women. However, they are also less likely to be offered preventive care or adjuvant therapy for this disease. Major gaps in evidence exist regarding the optimal evaluation and treatment of older women with breast cancer because of significant underrepresentation in clinical trials. Chronologic age alone is an inadequate predictor of treatment tolerance and benefit in this heterogeneous population. Multiple issues uniquely associated with aging impact cancer care, including functional impairment, comorbidity, social support, cognitive function, psychological state, and financial stress. Applying geriatric principles and assessment to this older adult population would inform decision making by providing estimates of life expectancy and identifying individuals most vulnerable to morbidity. Ongoing research is seeking to identify which assessment tools can best predict outcomes in this population, and thus guide experts in tailoring treatments to maximize benefits in older adults with breast cancer. PMID:19200420
Tele-ICU: the way forward in geriatric care?
Hao, Jun-Feng; Cui, Han-Min; Han, Jing-Ming; Bai, Jiu-Xu; Song, Xiaohua; Cao, Ning
Aging population is set to increase in the near future, and will need specialized care when admitted to ICUs. The elderly are beset with chronic conditions, such as cardiovascular, COPD, diabetes, renal complications and depression. Specialist opinions can now be made available through telemedicine facilities. Tele-ICU is a specialized hub consisting of highly skilled staff trained in critical care able to deliver timely, quality care service to patients admitted to ICUs in remote areas using highly advanced information technology services. These specialists in the tele-ICU hub are able to analyze and gather data arriving at timely interventional management decisions and provide this vital feedback to the nursing staff and doctors manning remote ICU locations where specialized intensivist may not be available. Known clinical benefits of such a system include better patient outcomes, reduced medical errors, mortality and reduced hospital length of stay. The main disadvantage in implementation could be the upfront high cost involved, for which low-cost models are being explored. In the face of delivering such remote care, it is up to the local health policy to make legislative changes to include associated legal and ethical issues. Considering the burgeoning aging population, tele-ICU could become the way forward in delivering geriatric critical care. PMID:24803284
Geriatric oncology in the Netherlands: a survey of medical oncology specialists and oncology nursing specialists.
Jonker, J M; Smorenburg, C H; Schiphorst, A H; van Rixtel, B; Portielje, J E A; Hamaker, M E
To identify ways to improve cancer care for older patients, we set out to examine how older patients in the Netherlands are currently being evaluated prior to oncological treatment and to explore the potential obstacles in the incorporation of a geriatric evaluation, using a web-based survey sent to Dutch medical oncology specialists and oncology nursing specialists. The response rate was 34% (183 out of 544). Two-thirds of respondents reported that a geriatric evaluation was being used, although primarily on an ad hoc basis only. Most respondents expressed a desire for a routine evaluation or more intensive collaboration with the geriatrician and 86% of respondents who were not using a geriatric evaluation expressed their interest to do so. The most important obstacles were a lack of time or personnel and insufficient availability of a geriatrician to perform the assessment. Thus, over 30% of oncology professionals in the Netherlands express an interest in geriatric oncology. Important obstacles to a routine implementation of a geriatric evaluation are a lack of time, or insufficient availability of geriatricians; this could be overcome with policies that acknowledge that quality cancer care for older patients requires the investment of time and personnel. PMID:24702775
Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients
Muffly, Lori S.; Kocherginsky, Masha; Stock, Wendy; Chu, Quynh; Bishop, Michael R.; Godley, Lucy A.; Kline, Justin; Liu, Hongtao; Odenike, Olatoyosi M.; Larson, Richard A.; van Besien, Koen; Artz, Andrew S.
Allogeneic hematopoietic cell transplantation is increasingly utilized in older adults. This study prospectively evaluated the prognostic utility of geriatric assessment domains prior to allogeneic transplantation in recipients aged 50 years and over. Geriatric assessment was performed prior to transplant, and included validated measures across domains of function and disability, comorbidity, frailty, mental health, nutritional status, and systemic inflammation. A total of 203 patients completed geriatric assessment and underwent transplant. Median age was 58 years (range 50–73). After adjusting for established prognostic factors, limitations in instrumental activities of daily living (HR 2.38, 95%CI: 1.59–3.56; P<0.001), slow walk speed (HR 1.80, 95%CI: 1.14–2.83; P=0.01), high comorbidity by hematopoietic cell transplantation-specific comorbidity index (HR 1.56, 95%CI: 1.07–2.28; P=0.02), low mental health by short-form-36 mental component summary (HR 1.67, 95%CI: 1.13–2.48; P=0.01), and elevated serum C-reactive protein (HR 2.51, 95%CI: 1.54–4.09; P<0.001) were significantly associated with inferior overall survival. These associations were more pronounced in the cohort 60 years and over. Geriatric assessment measures confer independent prognostic utility in older allogeneic transplant recipients. Implementation of geriatric assessment prior to allogeneic transplantation may aid appropriate selection of older adults. PMID:24816237
Cognitive Impairment Is the Major Risk Factor for Development of Geriatric Syndromes during Hospitalization: Results from the GIFA Study
Patrizia Mecocci; Eva von Strauss; Antonio Cherubini; Sara Ercolani; Elena Mariani; Umberto Senin; Bengt Winblad; Laura Fratiglioni
Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in
Learner-Centered Online Courses/Programs in Gerontology and Geriatrics: New Responses to Changing Needs of Health Professionals
ERIC Educational Resources Information Center
Cotter, J. James; Welleford, E. Ayn; Drain, Cecil B.
This article describes recent trends that have led to an emphasis on a learner-centered approach to gerontology and geriatrics education especially in distance-based education. A learner-centered approach to education has combined with technological advances to stimulate distance-enhanced education for students in geriatric and gerontology…
Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia
Tiina M Huusko; Pertti Karppi; Veikko Avikainen; Hannu Kautiainen; Raimo Sulkava
Objective To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. Design Preplanned subanalysis of randomised intervention study. Settting Jyv‰skyl‰ Central Hospital, Finland. Participants 243 independently living patients aged 65 years or older admitted to hospital with hip fracture. Intervention After surgery patients in the intervention group (n = 120) were referred to the geriatric ward
The Safety of Systemic Treatments That Can Be Used for Geriatric Psoriasis Patients: A Review
Wong, Jillian W.; Koo, John Y. M.
Background. Patients with moderate-to-severe psoriasis are often treated with systemic immunosuppressant agents that decrease immune system function. For the elderly, these medications are often problematic due to their already immunosuppressed state and comorbidities. However, there are few studies examining the effects of these medications on the elderly age group. Therefore, there is often discomfort among dermatologists treating elderly patients with psoriasis in utilizing systemic agents, frequently resulting in inadequate treatment. Objective. We review the safety profiles of systemic treatments often used to treat psoriasis and their possible adverse risks to the geriatric population. Methods. We conducted a search of PubMed's Medline database of articles published from 2000 to 2011, which resulted in 14 articles. Conclusion. Treating geriatric patients with moderate-to-severe psoriasis remains a challenge due to immunosenescence and comorbidities. More studies focusing on psoriasis treatment safety in the geriatric population are needed. PMID:22685455
Nursing students and geriatric care: the influence of specific knowledge on evolving values, attitudes, and actions.
Potter, Gail; Clarke, Tammie; Hackett, Susan; Little, Maureen
This descriptive study explored the influence of specific geriatric knowledge on second and third year nursing students in their provision of care to older adults. Nineteen student participants provided qualitative data on their values and beliefs about nursing older adults prior to their attendance at a 1-h session teaching about two assessment tools: SPICES (Sleep disorders, Problems with feeding, Incontinence, Confusion, Evidence of falls, Skin breakdown) and BPI-SF (Brief Pain Inventory-Short Form). Data were again collected following a 6-week practice experience in which the same students had the opportunity to implement the tools. Four emerging themes, beliefs, knowledge, attitudes, and application, suggested how the students' geriatric knowledge and attitudes evolved and took on personal meaning in their intermediate practice experiences. Their realization of the hegemony associated with devaluing of the care of older adults warrants further examination into how geriatric knowledge is conveyed and assimilated. PMID:23465846
Expanding palliative care nursing education in California: the ELNEC Geriatric project.
Kelly, Kathe; Thrane, Susan; Virani, Rose; Malloy, Pam; Ferrell, Betty
In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a 'good death' through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric 'train-the-trainer' project was launched in 2007 to increase the knowledge and educational skills of nurses and unlicensed staff providing end-of-life care for older adults in nursing homes, skilled nursing facilities, long-term care, and hospices. From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum. PMID:21537321
A four-year perspective of Society for Academic Emergency Medicine tests: an online testing tool for medical students.
Senecal, Emily L; Thomas, Stephen H; Beeson, Michael S
Nationwide survey findings that most U.S. emergency medicine clerkship directors were interested in participating in a methodologically rigorous student testing program prompted the development of the Society for Academic Emergency Medicine (SAEM) Medical Student Online Testing Service (SAEM Tests). This article describes the development of SAEM Tests and details usage and progress since the on-line release in June 2005. Specifically, we review the construction of SAEM Tests and present validity and difficulty statistics obtained at the first analysis of test performance 6 months after its release and again 12 months later after revisions aimed at enhancing test performance. We then review the current status of SAEM Tests and summarize future goals and directions. PMID:20053210
Thoracolumbar Spine Fractures in the Geriatric Fracture Center
Folbert, E. C.; Kraai, M.; Smit, R. S.; Hegeman, J. H.; van der Velde, D.
Introduction: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a vertebral fracture. Methods: This study is a retrospective cohort study, which included all patients with an age of 65 years and older, who were diagnosed with a vertebral fracture and where therefore admitted to the Geriatric Fracture Center over a period of 2 years. Primary outcome was the level of functioning 6 weeks and 3 months after admission. Results: We included 106 patients with 143 vertebral fractures, of which 61 patients were evaluated after 3 months. In our population, 53% of the patients had a fracture involving both middle and anterior columns. The majority of the patients functioned sufficiently 6 weeks and 3 months after admission. Analysis showed that age <80 years is an independent predictor of a sufficient level of functioning after 6 weeks. Discussion: The nonoperative treatment of elderly patients with a vertebral fracture leads to a sufficient level of functioning 6 weeks and 3 months after admission. In our population, only age <80 years is an independent predictor for a sufficient level of functioning 6 weeks after admission. The level of functioning at 6 weeks predicts the level of functioning 3 months after admission. On comparison, the level of functioning after early ambulation is equal to the level of functioning after immobilization. Where immobilization may lead to complications, early ambulation was not associated with new complications or neurological damage. Based on these advantages, the treatment of elderly patients with a fracture involving both middle and anterior columns may be altered from immobilization to mobilization in the future. PMID:25360330
[Geriatric problems seen in general practice in patients in nursing homes].
Thomas, J M
The general practitioner meets in long stay geriatrics polypathologic and frail patients. He is confronted with many problems: Staphylococcus aureus resistant to the methylpenicilline, ulcers of pressure, pain, depression, dementia, falls, etc. He will remain vigilant with ill-treat and the disorders of the nutrition. The communication will be improved by the use of validated scales. The nomination of a doctor coordinator will have to help to promote global geriatric assessment. The demography will involve the number of old patients. Sufficient financial means will have to be released in order to allow everyone to receive care of quality. PMID:11680194
[The geriatric perioperative unit, a high performance care department for elderly surgical patients].
Papas, Anne; Caillard, Laurence; Nion, Nathalie
For over a year Professor Marc Verny's geriatric department at Pitié-Salpętričre hospital in Paris has had ten beds set aside for the perioperative care of elderly people. This geriatric perioperative unit (UPOG) offers patients the skills of a multidisciplinary team trained in the specificities of caring for elderly patients often suffering from polypathology. The team works closely together around a common goal: the rapid return of the patient's autonomy during the postoperative period, crucial for the future of elderly people. So far UPOG's results have been very positive, as more than 90% of patients regain their autonomy after a short and uncomplicated period of postoperative care. PMID:21416906
Pharmacological approaches to cognitive deficits and incontinence (1899-2002): progress in geriatric care.
Bellantonio, Sandra; Kuchel, George A
In planning for the medical needs of our growing population of older adults, it has been assumed that modern pharmacology of common geriatric conditions includes strategies not considered in previous decades. However, examination of the 1899 edition of the Merck Manual demonstrates that many important contributors to geriatric disability had already started to be recognized in the 19th century. Moreover, some of the medications recommended for these conditions in 1899 were based on the same pharmacological principles as 'state-of-the-art' management options available in 2002. PMID:11931995
Faculty of Medicine Graduate School of Medicine
Miyashita, Yasushi
2007--2008 Faculty of Medicine Graduate School of Medicine PROSPECTUS The University of Tokyo #12;#12;Welcome to Faculty of Medicine, Graduate School of Medicine The University of Tokyo Takao Shimizu Dean, Faculty of Medicine, Graduate School of Medicine The University of Tokyo The Faculty of Medicine
NSDL National Science Digital Library
Science Update
A recent report in the journal Pediatrics questioned the effectiveness of over-the-counter children's cough medicines. In this Science Update, you'll hear more about the study, and why some medicines may have escaped this sort of rigorous testing.
NASA Technical Reports Server (NTRS)
Davis, Jeffrey R.
This abstract describes the content of a presentation for ground rounds at Mt. Sinai School of Medicine. The presentation contains three sections. The first describes the history of aerospace medicine beginning with early flights with animals. The second section of the presentation describes current programs and planning for future missions. The third section describes the medical challenges of exploration missions.
ERIC Educational Resources Information Center
Bochner, Arthur P.
In "Narrative Medicine: Honoring the Stories of Illness," Rita Charon paints an original and humane portrait of what it can mean to be a doctor, to live a life immersed in sickness and dedicated to wellness. Charon drops the veil, inviting readers to look at the secret, subjective, emotional face of medicine, a zone of self-censored feelings and…
Complementary and alternative medicine in US medical schools
Cowen, Virginia S; Cyr, Vicki
An analysis of complementary and alternative medicine (CAM) in US medical school curriculum was undertaken. Websites for 130 US medical schools were systematically analyzed for course listings and content. Half of the schools (50.8%) offered at least one CAM course or clerkship. A total of 127 different course listings were identified, embracing a range of topics and methods of instruction. The most frequently listed topics were traditional medicine, acupuncture, spirituality, and herbs, along with the general topic of CAM. Nearly 25.0% of the courses referenced personal growth or self-care through CAM practices, while only 11.0% referenced inter-professional education activities involving interaction with CAM providers. The most frequently reported instructional methods were lectures, readings, and observation of, or receiving a CAM treatment. The findings of this analysis indicated fewer medical schools offered instruction in CAM than previously reported and a wide range of approaches to the topic across the schools where CAM is taught. PMID:25709517
Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel.
Bahrmann, P; Wehling, M; Ropers, D; Flohr, J; Leischker, A; Röther, J
The present position paper summarises the outcomes of an expert panel discussion held by hospital-based and office-based physicians with ample experience in the treatment of geriatric patients. The optimal approach to stroke prevention in geriatric patients with atrial fibrillation (AF) has not been adequately clarified. Despite their high risk of stroke and clear indication for anticoagulation according to established risk scores, in practice geriatric AF patients often are withheld treatment because of comorbidities and comedications, concerns about low treatment adherence or fear of bleeding events, in particular due to falls. The panel agreed that geriatric patients should receive oral anticoagulation as a rule, unless a comprehensive neurological and geriatric assessment (including clinical examination, gait tests and validated instruments such as Modified Rankin Scale, Mini-mental state examination or Timed Test of Money Counting) provides sound reasons for refraining from treatment. All patients with a history of falls should be thoroughly evaluated for further evaluation of the causes. Patients with CHADS2 score ? 2 should receive anticoagulation even if at high risk for falls. The novel oral anticoagulants (NOAC) facilitate management in the geriatric population with AF (no INR monitoring needed, easier bridging during interventions) and have, based on available data, an improved benefit-risk ratio compared to vitamin K antagonists. Drugs with predominantly non-renal elimination are safer in geriatric patients and should be preferred. PMID:25285794
Medical School and VA Cooperation in Gerontology\\/Geriatrics Education
Joseph D. Alter; Sherman Kahn; Dawn L. Warren
The School of Medicine at Wright State University developed with support from the VA Medical School Assistance and Health Manpower Act of 1972 (PL 92-541). This laid the foundation for collaborative efforts between WSU SOM and DVAMC in the development of educational programs for medical students, residents, faculty, and staff from both facilities. The major emphasis of these joint programs
Geriatric Education in a Family Practice Residency Program--An Interdisciplinary Health-Care Team Approach.
ERIC Educational Resources Information Center
Jelly, Eric C.; Hawkinson, William P.
A program was designed to extend experience of residents and medical students rotating through Family Practice Center in the care of older patients. This educational experience was based on a group of representative geriatric cases at a nursing home and included paramedical personnel in service and educational elements. (Author)
Impact of Problem Alcohol Use on Patient Behavior and Caregiver Burden in a Geriatric Assessment Clinic
S. Pirzada Sattar; Prasad R. Padala; Delores McArthur-Miller; William H. Roccaforte; Steven P. Wengel; William J. Burke
There has been a growing interest in understanding issues surrounding alcohol use in late life. Information about the relationship of alcohol use to behavioral problems in older persons living in the community is particularly limited. This study used information obtained from an outpatient geriatric assessment clinic to study this relationship and the effects of these behaviors on caregivers. Data on
The Impact of VA's Geriatric Research, Education and Clinical Centers on Academic Affiliates
ERIC Educational Resources Information Center
Bragg, Elizabeth J.; Meganathan, Karthikeyan; Shay, Kenneth; Gilman, Stuart C.; Zeiss, Robert A.; Hettler, Debbie L.
The education mission of the Department of Veterans Affairs (VA) is to train health professionals to benefit VA and the United States. One approach for achieving that mission, along with VA's research and clinical missions, was the establishment of Geriatric Research, Education and Clinical Centers (GRECCs) in 1975. These were developed at VA…
Quality Assurance in Gerontological and Geriatric Training Programs: The European Case
ERIC Educational Resources Information Center
Politynska, Barbara; van Rijsselt, Rene J. T.; Lewko, Jolanta; Philp, Ian; Figueiredo, Daniella; De Sousa, Lilliana
Quality assurance (QA) in gerontological and geriatric education programs is regarded as essential to maintain standards, strengthen accountability, improve readability of qualifications, and facilitate professional mobility. In this article the authors present a summary of international developments in QA and elaborate four international trends,…
Validation of Geriatric Depression Scale--5 Scores among Sedentary Older Adults
ERIC Educational Resources Information Center
Marquez, David X.; McAuley, Edward; Motl, Robert W.; Elavsky, Steriani; Konopack, James F.; Jerome, Gerald J.; Kramer, Arthur F.
This study examined the validity of Geriatric Depression Scale--5 (GDS-5) scores among older sedentary adults based on its structural properties and relationship with external criteria. Participants from two samples (Ns = 185 and 93; M ages = 66 and 67 years) completed baseline assessments as part of randomized controlled exercise trials.…
A Brief Version of the Geriatric Depression Scale for the Chinese
ERIC Educational Resources Information Center
Cheng, Sheung-Tak; Chan, Alfred C. M.
Elderly persons (N=310) attending outpatient psychiatric clinics were given an interview on the 30-item Geriatric Depression Scale (T. L. Brink et al., 1982; J. A. Yesavage et al., 1983) and received an independent psychiatric evaluation. A 3-step binary logistic regression showed that 2 items measuring positive affect and 2 others measuring…
The Geriatric Hand: Correlation of Hand-Muscle Function and Activity Restriction in Elderly
ERIC Educational Resources Information Center
Incel, Nurgul Arinci; Sezgin, Melek; As, Ismet; Cimen, Ozlem Bolgen; Sahin, Gunsah
On the basis of the importance of hand manipulation in activities of daily living (ADL), deterioration of hand function because of various factors reduces quality and independence of life of the geriatric population. The aim of this study was to identify age-induced changes in manual function and to quantify the correlations between hand-muscle…
The Prevalence of Undiagnosed Geriatric Health Conditions among Adult Protective Service Clients
ERIC Educational Resources Information Center
Heath, John M.; Brown, Merle; Kobylarz, Fred A.; Castano, Susan
Purpose: We sought to determine the prevalence of remediable health conditions from in-home geriatric assessments of referred adult protective service (APS) clients suffering elder mistreatment. Design and Methods: We used a retrospective cohort study of 211 APS clients (74% female; age, M = 77 years) in two central New Jersey counties. Results:…
Michael L. Stotts
The nursing home as well as other health and social service agencies are vastly underdeveloped as teaching resources. Several historical reasons account for the gaps in geriatric health and medical education. To mimic the teaching hospital as a model for transmitting knowledge about aging to students is to direct learning into negative and unproductive pathways. Alternative curriculum designs are suggested.
Making sense of pragmatic criteria for the selection of geriatric rehabilitation measurement tools
Claudine Auger; Louise Demers; Bonnie Swaine
In geriatric rehabilitation, the selection of the most appropriate measurement tools involves pragmatic as well as psychometric considerations. However, there is no consensus about the conceptual and operational definitions of the pragmatic criteria involved in this selection. The objective of this research was to identify such operational criteria through a literature search between 1995 and 2004. Results identified operational criteria
SHORT REPORT Open Access Geriatric study in Europe on health effects of air
Paris-Sud XI, Université de
SHORT REPORT Open Access Geriatric study in Europe on health effects of air quality in nursing: The main long-term purpose of the GERIE study is to improve the health of elderly who permanently reside of housing and social integration) or in nursing homes (quality of healthcare and manage- ment
Development of an Instrument for Monitoring Food Intake of Geriatric Patients in Extended Care Facilities
Linda R Shoaf; Stella Hixson; Marylou Stephens
An easy to use instrument for monitoring food intake of geriatric patients was developed and tested in two skilled care facilities. The instrument, based on the Basic Food Groups, was simplified by a check system for quick and thorough completion by personnel with limited training. Food items were printed on the instrument to avoid recording error and to expedite use.
Hunger and Aversion: Drives That Influence Food Intake of Hospitalized Geriatric Patients
Danielle St-Arnaud-McKenzie; Catherine Paquet; Marie-Jeanne Kergoat; Guylaine Ferland; Laurette Dube ´
Background. Diminished appetite occurs frequently with aging and is considered an important clinical symptom of malnutrition, a condition associated with negative clinical outcome, decreased quality of life, and increased health care costs in hospitalized geriatric patients. Yet, in this population, research is scant on hunger and aversion, the two underlying drives that shape appetite, or on their influence on food
The reproducibility of a new dietary record routine in geriatric patients
Background and aim: Malnutrition in nursing home residents is an important clinical and public health problem. Knowledge is lacking about the reproducibility of dietary recording in geriatric patients. Few studies have described water intake in this age group. The aim of this study was to test the reproducibility of a 7-day dietary record routine in a clinical setting. Methods: The
Filipino Nursing Students' Behavioral Intentions toward Geriatric Care: A Structural Equation Model (SEM)
ERIC Educational Resources Information Center
de Guzman, Allan B.; Jimenez, Benito Christian B.; Jocson, Kathlyn P.; Junio, Aileen R.; Junio, Drazen E.; Jurado, Jasper Benjamin N.; Justiniano, Angela Bianca F.
Anchored on the key constucts of Ajzen's Theory of Planned Behavior (1985), this paper seeks to test a model that explores the influence of knowledge, attitude, and caring behavior on nursing students' behavioral intention toward geriatric care. A five-part survey-questionnaire was administered to 839 third and fourth year nursing students from a…
Gender Bias in the Diagnosis of a Geriatric Standardized Patient: A Potential Confounding Variable
ERIC Educational Resources Information Center
Lewis, Roya; Lamdan, Ruth M.; Wald, David; Curtis, Michael
Background: Gender bias has been reported in the diagnosis and treatment of patients with a variety of illnesses. In the context of our 10-station fourth year Objective Structured Clinical Evaluation, we queried whether this could influence diagnosis in a geriatric case. Case writers hypothesized that, due to this bias, the female standardized…
Interdisciplinary Collaboration in Gerontology and Geriatrics in Latin America: Conceptual Approaches and Health Care Teams
ERIC Educational Resources Information Center
Gomez, Fernando; Curcio, Carmen Lucia
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a…
The Structure of the Philadelphia Geriatric Center Morale Scale: A Reinterpretation.
ERIC Educational Resources Information Center
Liang, Jersey; Bollen, Kenneth A.
Examines the structure of the Philadelphia Geriatric Center (PGC) Morale Scale using a multiple indicator structural equation model. Based on the 1968 National Senior Citizens Survey, the model is consistently replicated across four subsamples. The claim that the PGC Morale Scale is multidimensional is only appropriate for first-order factors.…
Am J Geriatr Psychiatry . Author manuscript Insomnia symptoms in older adults: associated factors and gender
Paris-Sud XI, Université de
Am J Geriatr Psychiatry . Author manuscript Page /1 10 Insomnia symptoms in older firstname.lastname@example.com > Abstract Objectives The aim of this study was to examine the factors associated with insomnia in community-dwelling elderly as a function of the nature and number of insomnia symptoms (IS) . difficulty with initiating
An examination of the post-stroke and vascular depression hypotheses among geriatric rehabilitation patients
Benjamin Todd Mast
The current study examined the post-stroke and vascular depression hypotheses in terms of their distinctiveness from each other and from other depressive syndromes in late life. Data from 680 consecutively admitted geriatric rehabilitation patients were incorporated to examine whether these syndromes demonstrated different prevalence rates, patterns of symptom endorsement, clinical correlates, and rehabilitation outcomes. Although the prevalence of depression was
Evaluation of physiological work demands and low back neuromuscular fatigue on nurses working in geriatric wards
Ling Hui; Gabriel Y. F. Ng; Simon S. M. Yeung; Christina W. Y. Hui-Chan
This study evaluated the physiological demands and low back neuromuscular fatigue patterns following a daytime work shift of 21 female nurses working in geriatric wards. Subjects' heart rate (HR) at work was monitored for 8h and surface electromyogram (EMG) of their back muscle was recorded during a 1-minute horizontal trunk holding test before and after work. Results showed that the
Chlordimeform (CDM), a formamidine pesticide, had a profound effect on the cardiovascular function of geriatric rats. Two-year-old pentobarbital-anesthetized Sprague-Dawley rats (n=8) received sequential intravenous CDM injections of 5, 10, 30, and 60 mg/kg. A control group of ra...
Geriatrics Education in Psychiatric Residencies: A National Survey of Program Directors
ERIC Educational Resources Information Center
Warshaw, Gregg A.; Bragg, Elizabeth J.; Layde, Joseph B.; Meganathan, Karthikeyan; Brewer, David E.
Objective: The authors describe the current characteristics of geriatrics training within general psychiatry training programs. Methods: In the fall of 2006, a survey was mailed and made available online to all U.S. psychiatric residency program directors (N=181). Results: The response rate was 54% (n=97). Of the responding psychiatry programs,…
Juxtapositioning Geriatrics and Art: The Essence of Caring, Carer, and Cared-for in Films
Allan B. de Guzman; Bobbie Jo H. Carungcong; Jasper Q. Castillo; Joyce Anne A. Castillo; Jenelyn S. Castro
The need to revolutionize geriatric nursing is dawning. However, there is a negative view regarding this nursing field. The dearth of literature on the use of theatrical films to surface universal realities in a care-driven profession has led to this attempt of bringing to reality the essences of caring, carer, and cared-for and their interactions with each other. This paper
Geriatric Education across 94 Million Acres: Adapting Conference Programming in a Rural State
ERIC Educational Resources Information Center
Murphy-Southwick, Colleen; McBride, Melen
Montana, a predominantly rural state, with a unique blend of geography and history, low population density, and cultural diversity represents the challenges for program development and implementation across remote areas. The paper discusses two statewide multidisciplinary geriatric education programs for health professionals offered by the…
Growing Old is Mandatory But Growing Up is Optional: An Explanation to Geriatrics
Sahoo, Pradyumna KU; Bhuyan, Sanat KU; Misra, Satya Ranjan; Pati, Abhishek Rajan
Growing old is an inevitable process and aging graciously requires a healthy body where oral cavity occupies an important place. Geriatric dentistry is a specialized multidisciplinary branch of general dentistry designed to provide dental services to elderly patients. The rise in life expectancy has attributed to the substantial reduction in mortality which brought about by improved health care facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions. The goal of geriatric treatment is to achieve optimal oral health, thus enhancing overall health. This begins with a concerted effort between the patient and the healthcare and dental teams. When medical problems exist, the physician and other involved healthcare professionals should be consulted, as these diseases can affect the safety and efficacy of various dental treatments. Thus a unified approach should be followed to assist geriatric patients to maintain optimal oral health and a high quality of life. Here in, this article we have reviewed the categories geriatric patients are divided to, various aging theories, changes occurring in various systems with their effects on system along with the various dental effects and age changes in them and treatment needs and strategies' concerning the elderly population. PMID:25654057
Interdisciplinary Educational Approaches to Promote Team-Based Geriatrics and Palliative Care
ERIC Educational Resources Information Center
Howe, Judith L.; Sherman, Deborah Witt
Despite the increasing public demand for enhanced care of older patients and those with life-threatening illness, health professionals have had limited formal education in geriatrics and palliative care. Furthermore, formal education in interdisciplinary team training is limited. In order to remedy this situation, proactive interventions are being…
Effect of a Geriatric Educational Experience on Graduates Activities and Attitudes.
ERIC Educational Resources Information Center
Ettinger, R. L.; And Others
The 1975 to 1985 graduates of the University of Iowa College of Dentistry were surveyed to evaluate the influence on dental practice of a comprehensive geriatric dental curriculum introduced in 1980. Those who graduated before 1980 were more likely to be consultants in nursing homes than carrying out comprehensive care for this population.…
Burden and Correlates of Geriatric Depression in the Uyghur Elderly Population, Observation from Xinjiang, China
Lu, Chen; Tang, Weiming; Mahapatra, Tanmay; Wang, Yu; Wang, Xihua; Ma, Ying; Ben, Yanli; Cao, Xiaolin; Mahapatra, Sanchita; Ling, Min; Gou, Anshuan; Wang, Yanmei; Xiao, Jiangqin; Hou, Ming; Wang, Xiuli; Lin, Bo; Chen, Ruoling; Wang, Faxing; Hu, Zhi
Background With the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease. Methods A cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS). Results Among these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR?=?3.92, 95% CI 1.18–13.03), satisfaction regarding quality of life (AOR?=?0.53, 95% CI 0.37–0.84) and income (AOR?=?0.75, 95% CI 0.35–1.60), suffering from more chronic diseases (AOR?=?1.70, 95% CI 1.42–2.04), experiencing three or more negative events (AOR?=?1.72, 95% CI 0.92–3.22) and lack of ability to take self-care (AOR?=?2.20, 95% CI 1.09–4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation. Conclusion High prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life. PMID:25437860
Geriatric rehabilitation of stroke patients in nursing homes: a study protocol
Background Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. Methods/Design This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation. Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation. Discussion This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients. PMID:20346175
Faculty of Medicine Graduate School of Medicine
Miyashita, Yasushi
that integrated health sciences, preventive medicine, environmental medicine, and nursing will become increasingly of health and medicine, and to start a new program of scholarships for students interested in research; strengthening preventive medicine; improving hospital management and medical services delivery
Sward, Douglas G.; Bennett, Brad L.
BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes. PMID:25215140
Clinical significance of chemotherapy for geriatric patients with advanced or recurrent gastric cancer.
Kawaguchi, Tsutomu; Komatsu, Shuhei; Ichikawa, Daisuke; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo
Recent clinical trials, such as JCOG9912 and SPIRITS, excluded geriatric patients aged ?75 years. The clinical significance of intensive chemotherapy for geriatric patients with advanced or recurrent gastric cancer remains unclear. Between 2002 and 2010, 54 consecutive advanced or recurrent gastric cancer patients aged ?75 years were enrolled in this study. We analyzed the predictors of chemotherapy administration and evaluated the survival benefit of chemotherapy for geriatric patients with advanced or recurrent gastric cancer. A total of 23 geriatric patients received no chemotherapy (GP), whereas the remaining 31 patients were administered chemotherapy (GPC). Of the 54 patients, 20 had severe concomitant illnesses, such as cardiorespiratory disease. Lymph node involvement (P=0.044) and the absence of cardiorespiratory disease (P<0.001) were found to be independently associated with chemotherapy administration. The GPC group exhibited a significantly better prognosis compared to the GP group (median survival time, 19.4 vs. 13.6 months, respectively; P=0.043). GPC patients without cardiorespiratory disease tended to have a better prognosis compared to GP patients without cardiorespiratory disease (P=0.106), whereas there were no significant differences between GP and GPC patients with cardiorespiratory disease. However, administration of chemotherapy was identified as an independent prognostic factor by the Cox proportional hazards model (hazard ratio = 2.609; 95% confidence interval: 1.173-5.761; P=0.019). Therefore, chemotherapy appears to provide a survival benefit in geriatric patients with advanced or recurrent gastric cancer, particularly those without concomitant cardiorespiratory disease. PMID:25469275
Prevalence and Risk Factors of Depression in Geriatric Patients with Dermatological Diseases
Kim, Eun Kyung; Kim, Hyung Ok; Park, Young Min; Park, Chul Jong; Yu, Dong Su
Background Although rarely life threatening, dermatological diseases may have a considerable influence on a patient's quality of life and psychological well-being. As with morbidity and mental distress from other chronic diseases, a skin disorder can be the one of the main causes of depression in the geriatric population. Objective To determine the prevalence of depression in elderly patients with dermatological disease in Korea and to identify factors associated with depression. Methods Patients over the age of 60 years with dermatologic diseases were solicited for a questionnaire survey. The Geriatric Depression Scale (GDS) was used to obtain a patient-based measurement of depression. Additionally, demographic information and medical history were collected. Results The questionnaire was completed by 313 patients (39.94% men, mean age 69.04 years, mean disease duration 3.23 years). Dermatological disease overall had a significant effect on patients' depression (?2=177.13, p<0.0001), with a mean GDS score of 12.35 (out of 30). The patients who had a GDS score greater than 10 was 62.3% which indicated increased prevalence of mild to severe depression when compared to the general population among whom only 22.22% percent have GDS score greater than 10. In the univariate analysis, physical health, education level, and the presence of concurrent diseases were risk factors for geriatric depression. However, we did not find any demographic or disease related variables that were independent predictors of depression. Conclusion Geriatric patients with dermatological disease experience an increase burden of depression. Thus, it is important for clinicians to evaluate geriatric patients with dermatologic diseases for depression. PMID:24003268
The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS)
Rej, Soham; Segal, Marilyn; Low, Nancy C P; Mucsi, Istvan; Holcroft, Christina; Shulman, Kenneth; Looper, Karl
Objective: Despite being a common and potentially serious condition, nephrogenic diabetes insipidus (NDI) remains poorly understood in older lithium users. Our main objective was to compare the prevalence of NDI symptoms and decreased urine osmolality ([UOsm] < 300 milli-Osmoles [mOsm/kg]) among geriatric and adult lithium users. We also assessed NDI symptoms, serum sodium (Na+), and urine specific gravity (USG) as possible surrogate measures of decreased UOsm, and ascertained whether potential etiologic factors independently correlated with decreased UOsm. Method: This was a cross-sectional study of 100 consecutive outpatients treated with lithium from 6 tertiary care clinics, of which 45 were geriatric (aged 65 years and older) and 55 adult (aged 18 to 64 years). Patients completed a symptom questionnaire and underwent laboratory tests, including UOsm, serum Na+, and USG. Results: Geriatric and adult lithium users had similar rates of decreased UOsm (12.5%, compared with 17.9%, P = 0.74), but geriatric patients reported less symptoms (P < 0.05). Although UOsm did not correlate with symptoms or current serum Na+, USG of less than 1.010 was suggestive of UOsm of less than 300 mOsm/kg. Age, lithium duration, and serum lithium level were independently associated with UOsm. Conclusions: The prevalence of decreased UOsm is similar in geriatric and adult lithium users, but older patients are less likely to report urinary and thirst symptoms. Although subjective symptoms do not correlate with UOsm, USG may be a cost-efficient clinical surrogate measure for UOsm. We suggest clinicians increase their vigilance for decreased UOsm, especially in lithium users with advanced age, longer duration of lithium exposure, and higher lithium levels. This may potentially prevent lithium intoxication, falls, hypernatremic events, and renal dysfunction. PMID:25007407
Faculty of Medicine Graduate School of Medicine
Miyashita, Yasushi
2005--2006 Faculty of Medicine Graduate School of Medicine PROSPECTUS The University of Tokyo #12;#12;Welcome to Faculty of Medicine, Graduate School of Medicine The University of Tokyo Nobutaka Hirokawa Dean, Faculty of Medicine, Graduate School of Medicine The University of Tokyo The University of Tokyo Graduate
... that some of these treatment alternatives have no proven clinical effect. Regular exercise and relaxation techniques can ... use homeopathic remedies and dismiss valid therapies, delaying proven treatment for serious conditions. Holistic Treatments Holistic medicine ...
MedlinePLUS Videos and Cool Tools
... with differences in our genes. Genes, which encode proteins, are different among individuals. We will absorb and ... that are cleared or eliminated by the same proteins in the body, one medicine could compete for ...
Alternative and Integrative Medicine
... from, the development of conventional medicine. Examples include: Traditional Medicine: These alternative medicine systems often are the healthcare rituals practiced by a given culture (eg, Asian, Indian, African). Homeopathic Medicine: This alternative medicine system is ...
... medicines away. Sometimes you can choose between a generic medicine and a brand name medicine. Generic and brand name medicines work the same way. Generic medicine usually costs less. Talk to your doctor, pharmacist, ...
Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors
B. Sturtzel; C. Mikulits; C. Gisinger; I. Elmadfa
Introduction Constipation is a common problem in the elderly population, especially in geriatric wards. Laxatives are the most preferred\\u000a solution but current studies link constipation and laxative use to weight-loss and malnutrition in nursing homes. Dietary\\u000a fibers also affect stool weight and transit time. So, oat-bran effectiveness in reducing the need for bowel medication and\\u000a weight-loss for geriatric care patients was
End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for Clinical Trials in Oncology--International Society Of Geriatric Oncology position article.
Wildiers, Hans; Mauer, Murielle; Pallis, Athanasios; Hurria, Arti; Mohile, Supriya G; Luciani, Andrea; Curigliano, Giuseppe; Extermann, Martine; Lichtman, Stuart M; Ballman, Karla; Cohen, Harvey Jay; Muss, Hyman; Wedding, Ulrich
Selecting the most appropriate end points for clinical trials is important to assess the value of new treatment strategies. Well-established end points for clinical research exist in oncology but may not be as relevant to the older cancer population because of competing risks of death and potentially increased impact of therapy on global functioning and quality of life. This article discusses specific clinical end points and their advantages and disadvantages for older individuals. Randomized or single-arm phase II trials can provide insight into the range of efficacy and toxicity in older populations but ideally need to be confirmed in phase III trials, which are unfortunately often hindered by the severe heterogeneity of the older cancer population, difficulties with selection bias depending on inclusion criteria, physician perception, and barriers in willingness to participate. All clinical trials in oncology should be without an upper age limit to allow entry of eligible older adults. In settings where so-called standard therapy is not feasible, specific trials for older patients with cancer might be required, integrating meaningful measures of outcome. Not all questions can be answered in randomized clinical trials, and large observational cohort studies or registries within the community setting should be established (preferably in parallel to randomized trials) so that treatment patterns across different settings can be compared with impact on outcome. Obligatory integration of a comparable form of geriatric assessment is recommended in future studies, and regulatory organizations such as the European Medicines Agency and US Food and Drug Administration should require adequate collection of data on efficacy and toxicity of new drugs in fit and frail elderly subpopulations. PMID:24019549
Hot, blind, and mad: avoidable geriatric anticholinergic delirium.
Ochs, Kristen L; Zell-Kanter, Michele; Mycyk, Mark B
The elderly are particularly sensitive to delirium-inducing medications. We report a case of a 93-year-old woman who developed anticholinergic delirium from subcutaneous diphenhydramine that she received in the emergency department. This patient was reportedly allergic to "caine" anesthetic agents, and thus, subcutaneous diphenhydramine was administered as an alternative local anesthetic, as recommended in emergency medicine textbooks. Within 20 minutes of administration, the patient developed agitation, tachycardia, dilated pupils, and dry skin, consistent with a classic anticholinergic toxidrome. Diphenhydramine use is associated with a high incidence of anticholinergic adverse effects, especially in the elderly. Clinicians should carefully consider using diphenhydramine in this vulnerable population. PMID:21458946
Increased Basal and Alum-Induced Interleukin-6 Levels in Geriatric Patients Are Associated with Cardiovascular Morbidity
Compté, Nathalie; Boudjeltia, Karim Zouaoui; Vanhaeverbeek, Michel; De Breucker, Sandra; Pepersack, Thierry; Tassignon, Joel; Trelcat, Anne; Goriely, Stanislas
Background/Aim of the study Low-grade systemic inflammation was suggested to participate to the decline of physiological functions and increased vulnerability encountered in older patients. Geriatric syndromes encompass various features such as functional dependence, polymorbidity, depression and malnutrition. There is a strong prevalence of cardiovascular diseases and related risk factors and chronic cytomegalovirus infections in the geriatric population. As these underlying conditions were proposed to influence the inflammatory state, the aim of this study was to assess their potential contribution to the association of geriatric syndromes with inflammatory parameters. Methodology We recruited 100 subjects in the general population or hospitalized for chronic medical conditions (age, 23-96 years). We collected information on clinical status (medical history, ongoing comorbidities, treatments and geriatric scales), biological parameters (hematological tests, cytomegalovirus serology) and cytokines production (basal and alum-induced interleukin (IL)-1? and IL-6 levels). Using stepwise backward multivariate analyses, we defined which set of clinical and biological variables could be predictive for increased inflammatory markers. Principal Findings We confirmed the age-associated increase of circulating IL-6 levels. In contrast to geriatric scales, we found history of cardiovascular diseases to be strongly associated for this parameter as for high IL-6 production upon ex vivo stimulation with alum. Conclusions Association between low-grade inflammation and geriatric conditions could be linked to underlying cardiovascular diseases. PMID:24244750
Aw, Brian; Boraston, Suni; Botten, David; Cherniwchan, Darin; Fazal, Hyder; Kelton, Timothy; Libman, Michael; Saldanha, Colin; Scappatura, Philip; Stowe, Brian
Abstract Objective To define the practice of travel medicine, provide the basics of a comprehensive pretravel consultation for international travelers, and assist in identifying patients who might require referral to travel medicine professionals. Sources of information Guidelines and recommendations on travel medicine and travel-related illnesses by national and international travel health authorities were reviewed. MEDLINE and EMBASE searches for related literature were also performed. Main message Travel medicine is a highly dynamic specialty that focuses on pretravel preventive care. A comprehensive risk assessment for each individual traveler is essential in order to accurately evaluate traveler-, itinerary-, and destination-specific risks, and to advise on the most appropriate risk management interventions to promote health and prevent adverse health outcomes during travel. Vaccinations might also be required and should be personalized according to the individual traveler's immunization history, travel itinerary, and the amount of time available before departure. Conclusion A traveler's health and safety depends on a practitioner's level of expertise in providing pretravel counseling and vaccinations, if required. Those who advise travelers are encouraged to be aware of the extent of this responsibility and to refer all high-risk travelers to travel medicine professionals whenever possible. PMID:25500599
Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.
Campbell-Detrixhe, Dia D; Grassley, Jane S; Zeigler, Vicki L
Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology. PMID:23735710
Lower bone mineral density in geriatric patients with monoclonal gammopathy of undetermined significance.
Dizdar, Omer; Erman, Mustafa; Cankurtaran, Mustafa; Halil, Meltem; Ulger, Zekeriya; Yavuz, Burcu Balam; Ariogul, Servet; Pinar, Asli; Harputluoglu, Hakan; Kars, Ayse; Celik, Ismail
The aim of this study was to investigate the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in a geriatric population in Turkey and compare bone mineral densities and related laboratory parameters of MGUS patients with those who do not have MGUS. Among 1,012 patients enrolled, monoclonal band was detected in serum samples of 22 patients (2.17%), most of which were IgG type. Further tests revealed multiple myeloma and lung carcinoma in two patients. The remaining 20 patients were diagnosed with MGUS (1.97%). The clinical and laboratory parameters of patients with and without MGUS were mostly comparable; however, bone mineral density measurements of patients with MGUS were significantly lower than those without MGUS (p = 0.007). We suggest evaluation of geriatric patients with MGUS for the presence of osteopenia/osteoporosis considering the high frequency observed in this study. PMID:17874101
The French Society of Geriatrics and Gerontology position paper on the concept of integration
Somme, Dominique; Trouvé, Hélčne; Passadori, Yves; Corvez, Alain; Jeandel, Claude; Bloch, Marie-Aline; Ruault, Genevičve; Dupont, Olivier; de Stampa, Matthieu
Introduction The concept of integration, although dating from the 1990s, has only recently appeared in French public health policy. It must be linked with 'coordination', which is the base of most French public policies applied to geriatrics since the 1960s. Herein, we report the French Society of Geriatrics and Gerontology working group's findings according to three axes: definition of integration, objectives of this organisational approach and the means needed to achieve them. Discussion Integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, financing, interventions and action-reports on the latter. Integration must be accompanied by a local dedicated professional (the 'pilot'). Results of recent experiments showed that it is possible to implement integrative dynamics in France. PMID:24868197
Management of diabetes mellitus type-2 in the geriatric population: Current perspectives
Bajwa, Sukhminder Jit Singh; Sehgal, Vishal; Kalra, Sanjay; Baruah, Manash Pratim
The prevalence of diabetes mellitus (DM) has increased exponentially throughout the world and there is rapid increase in elderly diabetics. DM is associated with increased mortality and considerable morbidity including stroke, heart disease, and diminished quality of life in the elderly. However, the unique features of geriatric diabetes have not been given due a prominence in medical literature. Hypoglycemia remains the biggest complicating factor and needs to be avoided in the elderly. Most people in the geriatric age group have some degree of renal insufficiency and medications need to be adjusted wisely with changing renal profile. Because safer and more effective pharmacological therapy is available, an individual approach to DM in the elderly is essential. PMID:25035634
Issues of attraction, retention, and affective states for geriatric nurse practitioners in long-term care
Nancy J. Karlin; Karen Schneider; Shanti Pepper
Limited research exists on self-reported geriatric nurse practitioner (GNP) perceptions. Thirty-six GNPs completed a survey for level of importance rather than rank-order. Subjects also completed the Profile of Mood States. Through the use of Pearson correlation techniques, results indicate that the number of years in nursing was related to appreciation from patients, one of the factors keeping GNPs satisfied with
Serum vitamin D concentration and short-term mortality among geriatric inpatients in acute care settings
Cédric Annweiler; Sophie Pochic; Bruno Fantino; Erick Legrand; Régis Bataille; Manuel Montero-Odasso; Olivier Beauchet
Introduction Vitamin D insufficiency is related to acute medical conditions known to increase the risk of short-term death in older adults.\\u000a The objective of this study was to determine whether serum 25-hydroxyvitamin D (25OHD) concentrations were associated with\\u000a the occurrence of in-hospital mortality in geriatric acute care settings while taking into account all characteristics likely\\u000a to improve the rate of in-hospital
Community Interventions for Older Adults with Comorbid Substance Abuse: The Geriatric Addictions Program (GAP)
Carol S. DAgostino; Kristen L. Barry; Frederic C. Blow; Carol Podgorski
Objective: The purpose of this paper was to provide an initial evaluation of an innovative, model community-based intervention program, the Geriatric Addictions Program (GAP), designed to assist older adults who have substance abuse and co-occurring mental health problems in accessing services and changing health behaviors.Methods: On entry into the program, an interview using standardized substance abuse and mental health instruments
Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
Kim, Sunghye; Brooks, Amber K; Groban, Leanne
Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ?65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. PMID:25565783
Factors Associated With Frequent Admissions to an Acute Geriatric Psychiatric Inpatient Unit
Benjamin K. P. Woo; Shahrokh Golshan; Edward C. Allen; John W. Daly; Dilip V. Jeste; Daniel D. Sewell
As a first step toward developing strategies to reduce the frequency of psychiatric hospitalizations, the authors retrospectively collected and analyzed demographic and clinical variables from 424 consecutive admissions to a university-based geriatric psychiatry inpatient unit over a 20-month period. The study sample was dichotomized into patients who were admitted more than one time (35.6%) versus those with a single admission.
Predictors of a nursing home placement from a non-acute geriatric hospital
B S Aditya; J C Sharma; S C Allen; M Vassallo
Background: Identifying patients who need Nursing Home (NH) care following a hospital admission is important.Objective: To identify the factors that predispose to an NH discharge.Design: Prospective observational study with blinded end-point evaluation.Setting: A non-acute geriatric hospital.Subjects: Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness.Main outcome measures: Discharge to an NH or home.Results:
Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?
T. J. Luger; C. Kammerlander; M. Gosch; M. F. Luger; U. Kammerlander-Knauer; T. Roth; J. Kreutziger
The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the\\u000a medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The\\u000a purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in
Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners
Ching Lan; Jin-Shin Lai; May-Kuen Wong; Mei-Li Yu
Objective: To evaluate the health-related fitness of geriatric Tai Chi Chuan (TCC) practitioners.Design: Case-control study of a TCC group and a group of sedentary controls.Setting: Research project at a hospital-based exercise physiology laboratory.Participants: Seventy-six community-dwelling senior persons (mean age 69.3 ± 3.9yr), a TCC group that included 22 men and 19 women and a control group of sedentary subjects that
Striking Denervation of Neuromuscular Junctions without Lumbar Motoneuron Loss in Geriatric Mouse Muscle
Chai, Ruth Jinfen; Vukovic, Jana; Dunlop, Sarah; Grounds, Miranda D.; Shavlakadze, Thea
Reasons for the progressive age-related loss of skeletal muscle mass and function, namely sarcopenia, are complex. Few studies describe sarcopenia in mice, although this species is the mammalian model of choice for genetic intervention and development of pharmaceutical interventions for muscle degeneration. One factor, important to sarcopenia-associated neuromuscular change, is myofibre denervation. Here we describe the morphology of the neuromuscular compartment in young (3 month) compared to geriatric (29 month) old female C57Bl/6J mice. There was no significant difference in the size or number of motoneuron cell bodies at the lumbar level (L1–L5) of the spinal cord at 3 and 29 months. However, in geriatric mice, there was a striking increase (by ?2.5 fold) in the percentage of fully denervated neuromuscular junctions (NMJs) and associated deterioration of Schwann cells in fast extensor digitorum longus (EDL), but not in slow soleus muscles. There were also distinct changes in myofibre composition of lower limb muscles (tibialis anterior (TA) and soleus) with a shift at 29 months to a faster phenotype in fast TA muscle and to a slower phenotype in slow soleus muscle. Overall, we demonstrate complex changes at the NMJ and muscle levels in geriatric mice that occur despite the maintenance of motoneuron cell bodies in the spinal cord. The challenge is to identify which components of the neuromuscular system are primarily responsible for the marked changes within the NMJ and muscle, in order to selectively target future interventions to reduce sarcopenia. PMID:22164231
[Social work in geriatric clinics--between autonomy and functional organization].
Thierau, D
Geriatric therapy is defined through interdisciplinarity, teamwork, and multiprofessionality. Besides questions of medical therapy, psychosocial dimensions of elderly are highly relevant. Social work is mostly described as an important profession in the process of geriatric therapy. This work refers to the presentation and discussion of the results of an interdisciplinary study to the role of social work in German geriatric hospitals. It shows that the role of social work is determined by the various perceptions of the professions. Another influence on it is by the structures of the hospital. Social workers defines their activities through the relationship to the client; the other professions recognize the tasks of social work in a very diffusely way, mostly reduced in connection with the management of dismission of the patient from hospital. The professional education of social workers is not well known by the nurses and doctors. The fact that social workers are mostly acting under the responsibility of doctors, leads to a definition of problems and aims from a medical point of view. In many of the hospitals there are distinct problems of communication and cooperation between the professions. If the profession of social workers wants to contribute to the reduction of these impediments of communication and cooperation, they must actively and constructively communicate with the other professions and become more clear about their own professional way of acting. PMID:9848241
Development and dissemination of Web-based clinical simulations for continuing geriatric nursing education.
Kowlowitz, Vicki; Davenport, Carolyn S; Palmer, Mary H
This article describes the process of developing and disseminating a Web-based library of geriatric clinical simulations used in continuing education workshops. Twenty-six peer-reviewed clinical simulations were developed on topics reflecting prevalent acute illnesses, conditions, or sentinel events that, if left undetected or untreated, could cause further comorbidity, hospitalization, or death. Geriatric nursing competencies identified by The John A. Hartford Foundation Institute for Geriatric Nursing were also incorporated. More than 700 workshop attendees and others have used these online clinical simulations. User evaluations of realism, accuracy of the situation or problem portrayed, and relevance to practice were rated as excellent or very good by more than 85% of the users. The University of North Carolina at Chapel Hill Center for Lifelong Learning Web site will offer this library with associated American Nurses Credentialing Center contact hours. This online access provides nurses high-quality continuing education offerings to increase knowledge and improve competence in the care of aging adults. PMID:19452737
ERIC Educational Resources Information Center
Phillipson, J. David
Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)
Wagner, H.N. Jr.
In 1985 and 1986 nuclear medicine became more and more oriented toward in vov chemistry, chiefly as a result of advances in positron emission tomography (PET). The most important trend was the extension of PET technology into the care of patients with brain tumors, epilepsy, and heart disease. A second trend was the increasing use of single-photon emission computed tomography (SPECT).
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Office of the Professions.
New York State education law, rules, and regulations concerning the practice of medicine are presented, along with requirements and procedures for obtaining licensure and first registration as a physician. State statutory provisions cover: duration and registration of a license, practice and regulation of the profession, supervision by the Board…
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Office of the Professions.
A reference guide to laws, rules, and regulations that govern medical practice in New York State is presented. After an overview of professional regulation in the state, licensing requirements/procedures for medicine are described including education and postgraduate training requirements, state licensing examinations, and application…
Kay, Mark A.
center; such as Geriatrics, Cardiac rehabilitation, and cancer patients, helping them-101 STANFORD CA 94305 email@example.com Spring 2013 To new patients of Dr the Physician-PA relationship, Physician Assistants exercise autonomy in medical decision
Major diagnosis and content areas of the 40 online cases that constitute the formal curriculum of the UWSOM Family Medicine Clerkship
Maxwell, Bruce D.
FMCases Case# 3 65-year-old female with insomnia - Mrs. Gomez Major Diagnosis: Depression Content areas: 1. Insomnia in the elderly 2. Major Depressive Disorder Diagnosis: Ankle Sprain Content areas: 1. Ankle pain: differential, history
Assembling cyavanapr?sh, Ayurveda's best-selling medicine.
Bode, Maarten
The paper discusses the many forms and representations of cyavanapr?sh, Ayurveda's best-selling medicine, already mentioned in Caraka's Compendium (c. 200 CE). The medicine's compositions, applications, and meanings, change over time and from locality to locality. Cyavanapr?sh is, for example, a patriotic formula, a booster of the immune system, a modern geriatric drug, and one of the elements in canonical Ayurvedic treatments. In the beginning of the 19th century cyavanapr?sh was a patriotic formula for fortifying Indian bodies and the nascent Indian nation. Nowadays the medicine is a Fast Moving Consumer Good (FMCG) and a money maker for Dabur India Ltd., the world largest Ayurvedic manufacturer. Instead of vitalising the nation its consumption now promises to make urban middle class consumers effectively modern. Branding and modern science must make Dabur Chyawanprash attractive in the eyes of these consumers. Ayurveda and cyavanapr?sh are also part of a global counter culture marked by neo-Orientalism and Ayurvedic medicines as facilitators of spirituality. The marketing of cyavanapr?sh by India's largest Ayurvedic manufacturer is used as a case study for discussing the proliferation of Ayurvedic brands and its critics. The imaging of Ayurvedic brands such as Dabur Chyawanprash threatens to obscure the fact that Ayurveda represents a unique way of looking upon health, disease and the human body. The proliferation of brands also makes Ayurvedic medicines more expensive and puts pressure on the natural environment as the main supplier of Ayurvedic ingredients. PMID:25639150
Ortho-Geriatric Care Models and Outcomes in Hip Fracture Patients: A Systematic Review and Meta-Analysis
Grigoryan, Konstantin V.; Javedan, Houman; Rudolph, James L.
Objectives Hip fractures are common, morbid, and costly health events that threaten the independence and function of older patients. The purpose of this systematic review and meta-analysis was to determine if ortho-geriatric collaboration models improve outcomes. Data Sources Articles in English and Spanish languages were searched in electronic databases including MEDLINE, CINAHL, EMBASE, and the Cochrane Registry from 1992 to 2012. Study Selection Studies were included if they described an inpatient multidisciplinary approach to hip fracture management involving an orthopedic surgeon and a geriatrician. Studies were grouped into three categories: routine geriatric consultation, geriatric ward with orthopedic consultation, and shared care. After independent review of 1,480 citations by two authors, 18 studies (9,094 patients) were identified as meeting the inclusion criteria. Data Extraction In-hospital mortality, length of stay, and long-term mortality outcomes were collected. Data Synthesis A random effects model meta-analysis determined whether the ortho-geriatric collaboration was associated with improved outcomes. The overall meta-analysis found ortho-geriatric collaboration was associated with a significant reduction of in-hospital mortality (RR 0.60, 95%CI 0.43, 0.84) and long-term mortality (RR 0.83, 95%CI 0.74, 0.94). Length of stay (SMD ?0.25, 95%CI ?0.44, ?0.05) was significantly reduced, particularly in the shared care model (SMD ?0.61, 95%CI ?0.95, ?0.28), but heterogeneity limited this interpretation. Other variables such as time to surgery, delirium, and functional status were measured infrequently. Conclusions This meta-analysis supports ortho-geriatric collaboration to improve mortality after hip repair. Further study is needed to determine the best model of ortho-geriatric collaboration, and if these partnerships improve functional outcomes. PMID:23912859
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The international oil industry, catalyzed by a surge in exploration and production projects in remote regions, is giving health care for its travelers and expatriates a high priority. L.R. Aalund, the Journal`s Managing Editor--Technology, reports on why and how this is happening now. He covers this in articles on: health care in Russia, air ambulance evacuations, and the deployment of remote paramedics. Aalund gathered the information during trips to Finland and Russia and interviews with oil industry personnel, physicians, and other medical professionals in North America, Europe, and Siberia. Titles of the four topics presented in this special section on remote medicine are as follows: Oil companies focus on emergency care for expats in Russia; Air ambulance plan can be critical; Remote paramedics have high level of training; and Other facets of remote medicine.
Murawski, K.; Peetoom, F.
These proceedings contain 24 selections, including papers presented at the conference of American Red Cross held in May 1985, on the Subject of transfusion medicine. Some of the titles are: Fluosol/sup R/-DA in Radiation Therapy; Expression of Cloned Human Factor VIII and the Molecular Basis of Gene Defects that Cause Hemophilia; DNA-Probing Assay in the Detection of Hepatitis B Virus Genome in Human Peripheral Blood Cells; and Monoclonal Antibodies: Convergence of Technology and Application.
Mason, Cindy; Mason, Earl
The paper introduces haptic medicine--healthcare based on loving touch for healing and preventing disease. We describe the effects of loving touch (a square inch of our skin has over 1000 nerves) on the body, brain and mind. We describe two web-based health education and media projects. The first, HYPERLINK "http://www.21stcenturymed.org" www.21stcenturymed.org is a place for health practitioners to start learning about touch and resources. The second project, Humans Without Borders, is a multi-lingual self help education website for everyday people. Teaching materials for these projects are based on our previous work with a form of haptic medicine known as psychophysiophilosophy with patients at Stanford Hospital, Kaiser Permanente and Lucille Packard Children's Hospital. We describe psychophysiophilosophy, relate motherly love to recent discoveries in neurosciences and give hints on ways to increase motherly love in each of us. We present a plan for moving into the future by re-introducing haptic medicine into our daily lives through self-help and as an adjunct for current physician practice. There is an exercise in self-help for the reader and an appendix of recent clinical research with profound benefits on the use of human touch for over 40 conditions. PMID:19745495
Microbial Diversity and Evidence of Novel Homoacetogens in the Gut of Both Geriatric and Adult Giant Pandas (Ailuropoda melanoleuca)
Tun, Hein Min; Mauroo, Nathalie France; Yuen, Chan San; Ho, John Chi Wang; Wong, Mabel Ting; Leung, Frederick Chi-Ching
Recent studies have described the bacterial community residing in the guts of giant pandas, together with the presence of lignocellulolytic enzymes. However, a more comprehensive understanding of the intestinal microbial composition and its functional capacity in giant pandas remains a major goal. Here, we conducted a comparison of bacterial, fungal and homoacetogenic microbial communities from fecal samples taken from two geriatric and two adult captive giant pandas. 16S rDNA amplicon pyrosequencing revealed that Firmicutes and Proteobacteria are the most abundant microbiota in both geriatric and adult giant pandas. However, members of phylum Actinobacteria found in adult giant pandas were absent in their geriatric counterparts. Similarly, ITS1 amplicon pyrosequencing identified developmental changes in the most abundant fungal classes from Sordariomycetes in adult pandas to Saccharomycetes in geriatric pandas. Geriatric pandas exhibited significantly higher abundance of a potential probiotic fungus (Candida tropicalis) as compared to adult pandas, indicating their importance in the normal digestive physiology of aged pandas. Our study also reported the presence of a lignocellulolytic white-rot fungus, Perenniporia medulla-panis, and the evidence of novel homoacetogens residing in the guts of giant pandas. PMID:24475017
Microbial diversity and evidence of novel homoacetogens in the gut of both geriatric and adult giant pandas (Ailuropoda melanoleuca).
Tun, Hein Min; Mauroo, Nathalie France; Yuen, Chan San; Ho, John Chi Wang; Wong, Mabel Ting; Leung, Frederick Chi-Ching
Recent studies have described the bacterial community residing in the guts of giant pandas, together with the presence of lignocellulolytic enzymes. However, a more comprehensive understanding of the intestinal microbial composition and its functional capacity in giant pandas remains a major goal. Here, we conducted a comparison of bacterial, fungal and homoacetogenic microbial communities from fecal samples taken from two geriatric and two adult captive giant pandas. 16S rDNA amplicon pyrosequencing revealed that Firmicutes and Proteobacteria are the most abundant microbiota in both geriatric and adult giant pandas. However, members of phylum Actinobacteria found in adult giant pandas were absent in their geriatric counterparts. Similarly, ITS1 amplicon pyrosequencing identified developmental changes in the most abundant fungal classes from Sordariomycetes in adult pandas to Saccharomycetes in geriatric pandas. Geriatric pandas exhibited significantly higher abundance of a potential probiotic fungus (Candida tropicalis) as compared to adult pandas, indicating their importance in the normal digestive physiology of aged pandas. Our study also reported the presence of a lignocellulolytic white-rot fungus, Perenniporia medulla-panis, and the evidence of novel homoacetogens residing in the guts of giant pandas. PMID:24475017
College of Medicine RM Radiation Medicine
MacAdam, Keith
College of Medicine RM Radiation Medicine KEY: # = new course * = course changed = course dropped and advanced topics in nuclear medicine imaging physics, including positron emission tomographic procedures IN RADIATION MEDICINE. (1-6) Applied field work at the graduate level in the sciences relating to radiation
College of Medicine MED Internal Medicine
MacAdam, Keith
College of Medicine MED Internal Medicine KEY: # = new course * = course changed = course dropped. (Same as MI/PHA 616.) MED 815 FIRST-YEAR ELECTIVE, MEDICINE. (1-3) With the advice and approval of his of Medicine. The intent is to provide the student an opportunity for exploration and study in an area which
College of Medicine ER Emergency Medicine
MacAdam, Keith
College of Medicine ER Emergency Medicine KEY: # = new course * = course changed = course dropped University of Kentucky 2013-2014 Undergraduate Bulletin 1 ER 815 FIRST-YEAR ELECTIVE, EMERGENCY MEDICINE. (1 offered by the Department of Emergency Medicine. The intent is to provide the student an opportunity
Master in Molecular Medicine Faculty of Medicine
Pfeifer, Holger
Master in Molecular Medicine Faculty of Medicine February 2010 #12;University of Ulm There are many of the Master program The English Master course of studies combines the disciplines Biology and Medicine of research, development and application in the field of molecular medicine especially in universities
Pediatric Clerkship Inpatient Rotation
Issa, Naoum
Oral and Written Communication Professional Behavior OME NEW Peds IR Mid Eval Did Not Observe Unacceptable Fair Good Excellent Outstanding 9. Demonstrates reliability and professional responsibility and Management in the Pediatric Inpatient Rotation 1. Applies clinical knowledge in conducting a thorough history
NSDL National Science Digital Library
Cheryl Powers
In this open-ended multicultural lab activity, learners investigate the effectiveness of herbal remedies. Learners prepare extracts from plants that are used in a variety of herbal medicines; they test the antibiotic effects of the herbs on gram positive and gram negative bacteria, and look for antifungal effects using common molds. The effectiveness of the herbal extracts is compared with traditional antibiotic and antifungal preparations. Each group is in charge of their experimental design; variables include types of herbs chosen, methods of preparing extracts, microbes tested, and type of exposure of microorganisms to the extract (applied to agar surface, on sensitivity disks, in agar itself, heated, cooled, etc.). Adult supervision recommended.
Programs for Developing the Pipeline of Early-Career Geriatric Mental Health Researchers: Outcomes and Implications for Other Fields
Bartels, Stephen J.; Lebowitz, Barry D.; Reynolds, Charles F.; Bruce, Martha L.; Halpain, Maureen; Faison, Warachal E.; Kirwin, Paul D.
This report summarizes the findings and recommendations of an expert consensus workgroup that addressed the endangered pipeline of geriatric mental health (GMH) researchers. The workgroup was convened at the Summit on Challenges in Recruitment, Retention, and Career Development in Geriatric Mental Health Research in late 2007. Major identified challenges included attracting and developing early-career investigators into the field of GMH research; a shortfall of geriatric clinical providers and researchers; a disproportionate lack of minority researchers; inadequate mentoring and career development resources; and the loss of promising researchers during the vulnerable period of transition from research training to independent research funding. The field of GMH research has been at the forefront of developing successful programs that address these issues while spanning the spectrum of research career development. These programs serve as a model for other fields and disciplines. Core elements of these multicomponent programs include summer internships to foster early interest in GMH research (Summer Training on Aging Research Topics–Mental Health Program), research sponsorships aimed at recruitment into the field of geriatric psychiatry (Stepping Stones), research training institutes for early career development (Summer Research Institute in Geriatric Psychiatry), mentored intensive programs on developing and obtaining a first research grant (Advanced Research Institute in Geriatric Psychiatry), targeted development of minority researchers (Institute for Research Minority Training on Mental Health and Aging), and a Web-based clearinghouse of mentoring seminars and resources (MedEdMentoring.org). This report discusses implications of and principles for disseminating these programs, including examples of replications in fields besides GMH research. PMID:20042817
Boston University Family Medicine
Spence, Harlan Ernest
Boston University Family Medicine Global Health CollaborativeFamily Medicine As part of the Department of Family Medicine at Boston University, the Collaborative is committed to introducing and improving Family Medicine programs around the world. Family Medicine is a holistic specialty that attends
*Department of Medicine, University of Wisconsin and Geriatric Research, Education and Clinical Center, Veterans Administration Hospital, Madison, Wisconsin, USA
Wisconsin at Madison, University of
-pituitary-gonadal endocrine receptors, by modulating peripheral sex hormone levels in female mice. Ovariectomy (OVX; high serum gonadotropins, low serum sex steroids) had a differential effect on StAR protein levels University, Joondalup, Western Australia, Australia Sex steroids are essential for normal brain function
Reeve, Joanne
Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the recognition of quality in interpretation and knowledge generation within the qualitative research field, I propose a framework by which to evaluate the quality of knowledge generated within generalist, interpretive clinical practice. I describe three priorities for research in developing this model further, which will strengthen and preserve core elements of the discipline of general practice, and thus promote and support the health needs of the public. PMID:21805819
NSDL National Science Digital Library
From Flying Publisher, _HIV Medicine 2005_ is a free, online "medical textbook that provides a comprehensive and up-to-date overview of the treatment of HIV Infection." This edition is an update of the 2003 version of the textbook (reported on in the June 13, 2003 NSDL Scout Report for Life Sciences). Chapter titles in the textbook include HIV Testing, HIV and Pulmonary Diseases, Mitochondrial Toxicity, HIV and HBV Coinfections, and Traveling with HIV, to name a few. The textbook is available in both German and English. Please note that while certain sections of the 2005 edition are currently available, many sections are still in the process of being published on the site. Sections from the 2003 edition are standing in for some of the forthcoming 2005 sections. The entire 352-page 2003 edition is available for download at this site as well.
Engman, David M.
Breast Cancer Survivorship Program offers comprehensive care and management strategies for the uniquTHE CANCER INSTITUTES AT NORTHWESTERN MEDICINE CANCER SURVIVORSHIP INSTITUTE THE INSTITUTES AT NORTHWESTERN MEDICINE #12;THE INSTITUTES AT NORTHWESTERN MEDICINE Today more than ever, cancer survivors
Farm Medicine, Rural Health & Safety National Farm Medicine Center Established in 1981 in response to occupational health problems seen in farm patients coming to Marshfield Clinic, the National Farm Medicine Center ...
... information in Spanish ( en espańol ) Preventing HIV with medicine Get medicine right after you are exposed to ... to top More information on Preventing HIV with medicine Explore other publications and websites National HIV and ...
... Blood Pressure Tools & Resources Stroke More Managing Your Medicines Updated:Apr 22,2014 If you have heart ... Yourself • Tools & Resources Heart Insight Supplement: Know Your Medicines Keeping track of your medicines can be overwhelming. ...
Orthopaedic Surgery Sports Medicine
Oliver, Douglas L.
Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation Protocol Conditioning: Stationary bike Treadmill #12;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear
A longitudinal, experiential quality improvement curriculum meeting ACGME competencies for geriatrics fellows: lessons learned.
Callahan, Kathryn E; Rogers, Matthew T; Lovato, James F; Fernandez, Helen M
Quality improvement (QI) initiatives are critical in the care of older adults who are more vulnerable to substandard care. QI education meets aspects of core Accreditation Council of Graduate Medical Education competencies and prepares learners for the rising focus on performance measurement in health care. The authors developed, implemented, and evaluated a QI curriculum for geriatrics fellows. The evidence-based curriculum included didactics and a fellow-led QI intervention based on audit and feedback through the Practice Improvement Module in Care of the Vulnerable Elderly. QI knowledge, attitudes, and behaviors were assessed before and after the improvement project. Fellows' knowledge of QI improved (p = .0156), but behavior did not change significantly across a short-term improvement project. A structured focus group with fellows revealed themes of accountability and the importance of interprofessional teamwork in QI. QI education for geriatrics fellows can be feasible, well received, and prepare future physician leaders for patient-centered care, performance measurement, and effecting systems change. PMID:23972275
Family caregivers: a shadow workforce in the geriatric health care system?
Bookman, Ann; Harrington, Mona
Based on two years of fieldwork, conducted between March 2003 and March 2005 in the health care industry of the northeastern United States, this study shows that the work of family caregivers of elders goes far beyond previously recognized care in the home to acknowledge care inside health care facilities and in conjunction with community services. It reveals that family caregivers--untrained, undersupported, and unseen--constitute a "shadow workforce," acting as geriatric case managers, medical record keepers, paramedics, and patient advocates to fill dangerous gaps in a system that is uncoordinated, fragmented, bureaucratic, and often depersonalized. Detailed examination of what family caregivers actually do in traversing multiple domains reveals the extent of their contribution to and the weaknesses in the present geriatric health care system. It suggests that the experiences of family caregivers must be central to the creation of new policies and a more coordinated system that uses the complex work of family caregivers by providing the training and support that they need. PMID:18000158
Malnutrition in geriatric patients: diagnostic and prognostic significance of nutritional parameters.
Volkert, D; Kruse, W; Oster, P; Schlierf, G
Nutritional status was assessed in 300 geriatric patients aged 75 years or more using clinical, anthropometric, biochemical and immunologic methods. Relations between different assessment methods and their prognostic significance with regard to 18-month mortality were examined. For biochemical variables 10% (prealbumin, vitamin B6) to 37% (vitamins A and C) were below conventional limits. In 44% of the patients lymphocytes were diminished. 44% were anergic. Judgement of nutritional status by clinical impression resulted in 22% being deemed undernourished. Clinical diagnosis of undernutrition was associated with low anthropometric measurements (p less than 0.05 for all parameters) and a high prevalence of low biochemical values (p less than 0.05 for albumin, prealbumin, transferrin, vitamin A, vitamin B1). The mean values of all anthropometric variables, plasma proteins, vitamins A and C were significantly lower in patients who died within the following 18 months compared to survivors. The greatest prognostic significance was related to the clinical diagnosis of malnutrition. We conclude that clinical assessment is useful for the evaluation of nutritional status in geriatric patients and the best of numerous nutritional parameters to estimate risk of long-term mortality. PMID:1510351
Using case studies to evaluate students' ability to develop a geriatric interdisciplinary care plan.
Flaherty, Ellen; Hyer, Kathryn; Kane, Robert; Wilson, Nancy; Whitelaw, Nancy; Fulmer, Terry
The Geriatric Interdisciplinary Team Training (GITT) program, an educational intervention funded by The John A. Hartford Foundation of New York City, has trained more than 1800 health care professions students and clinicians throughout the United States. Evaluating the effectiveness of this training intervention has proven to be quite a challenge. Core measures were collected pre- and post-GITT training to evaluate student development as a result of GITT. This paper focuses on one of these core measures, the Test of Geriatric Interdisciplinary Care Planning (TGICP). This instrument, developed for the GITT program, is one mechanism created to test trainees' ability to develop an interdisciplinary plan of care. Using a case study methodology, this two-part instrument provides an innovative approach to quantifying and correlating responses from an interdisciplinary cohort of students. This paper will describe the development of the TGICP, including the creation and validation of the case studies, the framework for the questionnaire, and the coding and scoring mechanism created to evaluate trainee responses. PMID:15871931
Chagas Disease in 2 Geriatric Rhesus Macaques (Macaca mulatta) Housed in the Pacific Northwest
Dickerson, Mary F; Astorga, Nestor Gerardo; Astorga, Nestor Rodrigo; Lewis, Anne D
Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. It is endemic in Latin America but also is found in the southern United States, particularly Texas and along the Gulf Coast. Typical clinical manifestations of Chagas disease are not well-characterized in rhesus macaques, but conduction abnormalities, myocarditis, and encephalitis and megaesophagus have been described. Here we report 2 cases of Chagas disease in rhesus macaques housed in the northwestern United States. The first case involved a geriatric male macaque with cardiomegaly, diagnosed as dilated cardiomyopathy on ultrasonographic examination. Postmortem findings included myocarditis as well as ganglioneuritis in the esophagus, stomach, and colon. The second case affected a geriatric female macaque experimentally infected with SIV. She was euthanized for a protocol-related time point. Microscopic examination revealed chronic myocarditis with amastigotes present in the cardiomyocytes, ganglioneuritis, and opportunistic infections attributed to her immunocompromised status. Banked serum samples from both macaques had positive titers for T. cruzi. T. cruzi DNA was amplified by conventional PCR from multiple tissues from both animals. Review of their histories revealed that both animals had been obtained from facilities in South Texas more than 12 y earlier. Given the long period of clinical latency, Chagas disease may be more prevalent in rhesus macaques than typically has been reported. T. cruzi infection should be considered for animals with unexplained cardiac or gastrointestinal pathology and that originated from areas known to have a high risk for disease transmission. PMID:25296019
A System Design for Studying Geriatric Patients with Dementia and Hypertension Based on Daily Living Information
NASA Astrophysics Data System (ADS)
Xu, Weifeng; Betz, Willian R.; Frezza, Stephen T.; Liu, Yunkai
Geriatric patients with dementia and hypertension (DAH) suffer both physically and financially. The needs of these patients mainly include improving the quality of daily living and reducing the cost of long-term care. Traditional treatment approaches are strained to meet these needs. The goal of the paper is to design an innovative system to provide cost-effective quality treatments for geriatric patients with DAH by collecting and analyzing the multi-dimensional personal information, such as observations in daily living (ODL) from a non-clinical environment. The proposed ODLs in paper include activities, cleanliness, blood pressure, medication compliance and mood changes. To complete the system design, an incremental user-centered strategy is exploited to assemble needs of patients, caregivers, and clinicians. A service-oriented architecture (SOA) is employed to make full use of existing devices, software systems, and platforms. This health-related knowledge can be interpreted and utilized to help patients with DAH remain in their homes safely and improve their life quality while reducing medical expenditures.
Nonpharmacological therapeutic techniques to decrease agitation in geriatric psychiatric patients with dementia.
Mitchell, Ann M; Chiappetta, Laurel; Boucek, Lynn; Cain, Michelle; Patterson, Georgia; Owens, Kim; Herisko, Camellia; Stark, Kirsti Hetager
Agitation is not only a frequent and disturbing behavior for many patients with dementia, but it also troubles their caregivers and families. Many serious problems and side effects are associated with the use of medications to treat agitation; therefore, alternative approaches to treating agitation must be assessed. The current article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention for geriatric psychiatric inpatients with mild to moderate agitation. Thirty-two visits to the sensory room were made by 13 inpatients with dementia. A significant decrease occurred in the Pittsburgh Agitation Scale (PAS) total scores over time from pre-room to post-room intervention, as well as 1-hour post-room intervention (F = 95.3, p < 0.001). Significant effects were found for all PAS subscales (i.e., aberrant vocalizations, motor agitation, and resistance to care), with the exception of the aggression subscale. The multisensory room intervention was effective in decreasing some symptoms of agitation in the geriatric psychiatric patient, thus contributing to positive patient, family, and nursing outcomes. PMID:25347866
Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients
Lee, Jung-Hyun; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung
Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. Methods We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. Results In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). Conclusion Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery. PMID:22949964
Systematic Review of the Use of Online Questionnaires among the Geriatric Population
Remillard, Meegan L.; Mazor, Kathleen M.; Cutrona, Sarah L.; Gurwitz, Jerry H.; Tjia, Jennifer
Background/Objectives The use of internet-based questionnaires to collect information from older adults is not well established. This systematic literature review of studies using online questionnaires in older adult populations aims to 1. describe methodologic approaches to population targeting and sampling and 2. summarize limitations of Internet-based questionnaires in geriatric populations. Design, Setting, Participants We identified English language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in PubMed and EBSCO host between 1984 and July 2012. Inclusion criteria were: study population mean age ?65 years old and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by 2 investigators; 11 articles met inclusion criteria. Measurements Articles were extracted for study design and setting, patient characteristics, recruitment strategy, country, and study limitations. Results Eleven (11) articles were published after 2001. Studies had populations with a mean age of 65 to 78 years, included descriptive and analytical designs, and were conducted in the United States, Australia, and Japan. Recruiting methods varied widely from paper fliers and personal emails to use of consumer marketing panels. Investigator-reported study limitations included the use of small convenience samples and limited generalizability. Conclusion Online questionnaires are a feasible method of surveying older adults in some geographic regions and for some subsets of older adults, but limited Internet access constrains recruiting methods and often limits study generalizability. PMID:24635138
Addressing geriatric oral health concerns through national oral health policy in India
Singh, Abhinav; Purohit, Bharathi M
There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world's elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries. PMID:25584351
Could Some Geriatric Characteristics Hinder the Prescription of Anticoagulants in Atrial Fibrillation in the Elderly?
Vanderstraeten, Jacques
Several studies have reported underprescription of anticoagulants in atrial fibrillation (AF). We conducted an observational study on 142 out of a total of 995 consecutive ?75 years old patients presenting AF (14%) when admitted in an emergency unit of a general hospital, in search of geriatric characteristics that might be associated with the underprescription of anticoagulation therapy (mostly antivitamin K at the time of the study). The following data was collected from patients presenting AF: medical history including treatment and comorbidities, CHADS2 score, ISAR scale (frailty), Lawton's scale (ADL), GDS scale (mood status), MUST (nutrition), and blood analysis (INR, kidney function, and albumin). Among those patients for who anticoagulation treatment was recommended (73%), only 61% were treated with it. In the group with anticoagulation therapy, the following characteristics were observed more often than in the group without such therapy: a recent (?6 months) hospitalization and medical treatment including digoxin or based on >3 different drugs. Neither the value of the CHADS2 score, nor the geriatric characteristics could be correlated with the presence or the absence of an anticoagulation therapy. More research is thus required to identify and clarify the relative importance of patient-, physician-, and health care system-related hurdles for the prescription of oral anticoagulation therapy in older patients with AF. PMID:25295192
Serum albumin level at admission: mortality and clinical outcome in geriatric patients.
D'Erasmo, E; Pisani, D; Ragno, A; Romagnoli, S; Spagna, G; Acca, M
We evaluated serum albumin at time of admission, within 72 hours, in 135 geriatric patients who were older than 70 years to establish its role as a predictor of death and clinical outcome at time of discharge. Serum albumin values were reduced significantly in patients who died compared with those who were discharged in unchanged/impaired and improved conditions (3.01 +/- 0.68 g/dL, 3.18 +/- 0.55 g/dL, and 3.65 +/- 0.52 g/dL respectively, P < 0.0001). A correlation between serum albumin concentration at admission and number of days elapsed from admission and death was found (r = 0.43, P < 0.05). Mortality rate was 38.6% in patients with serum albumin values < 3.3 g/dL compared with 14.1% in those with albumin values > or = 3.3 g/dL (P < 0.005). Similar results were obtained even when the main diagnostic conditions, such as cardiocerebrovascular disease and cancer, were considered. The results demonstrate that in geriatric patients the serum albumin level at admission may be a predictor of mortality and clinical outcome at discharge. PMID:9216435
Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia.
Ismail, Zahinoor; Arenovich, Tamara; Granger, Robert; Grieve, Charlotte; Willett, Peggie; Patten, Scott; Mulsant, Benoit H
ABSTRACT Background: Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds. Methods: Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models. Results: A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS - a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS. Conclusions: Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources. PMID:25330847
... Teriparatide (Forteo); Denosumab (Prolia); Low bone density - medicines; Osteoporosis - medicines ... Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With ...
Faculty of Medicine Graduate School of Medicine
Miyashita, Yasushi
number of elderly people in our population, we know that integrated health sciences, preventive medicine the occasion, we also established the Museum of Health and Medicine in 2011. In addition, we are planning; strengthening preventive medicine; improving hospital management and medical services delivery
160 Am J Geriatr Psychiatry 9:2, Spring 2001 Longitudinal Study of Quality of Life in
160 Am J Geriatr Psychiatry 9:2, Spring 2001 Longitudinal Study of Quality of Life in People Stern, Ph.D. The authors examined three indicators of health-related quality of life in people Akey component in the investigation of health-re- lated quality of life (HRQL) is "direct inquiry con
Int J Geriatr Psychiatry . Author manuscript Neurological signs and late-life depressive symptoms in a community
Paris-Sud XI, Université de
Int J Geriatr Psychiatry . Author manuscript Page /1 8 Neurological signs and late-life depressive Portet 2 , Sylvaine Artero 2 , Marie-Laure Ancelin 2 , Karen Ritchie 2 Institute of Psychiatry1 likely to be present in participants with a previous history of neurological disorder. Conclusions We
Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival
ERIC Educational Resources Information Center
Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven
Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…
J Am Geriatr Soc. Author manuscript Successful aging: the contribution of early-life and midlife risk factors
Boyer, Edmond
, published in "Journal of the American Geriatrics Society 56, 6 (2008) 1098-105" DOI : 10.1111/j.1532 Department of Epidemiology and Public Health1 University College of London (UCL), 1-19 Torrington Place early life factors (education, height, father s social position) and midlife social, behavioral
596 Am J Geriatr Psychiatry 12:6, November-December 2004 Altered PET Functional Brain Responses
596 Am J Geriatr Psychiatry 12:6, November-December 2004 Altered PET Functional Brain Responses tomography (PET), they imaged 32 healthy subjects (26 non- 4 carriers and 6 4 carriers) performing a serial, with the "activation" difference (TDSD PET counts) as the dependent variable and the APOE genotype (presence versus ab
Use of Games as a Learner-Centered Strategy in Gerontology, Geriatrics, and Aging-Related Courses
ERIC Educational Resources Information Center
Schmall, Vicki; Grabinski, C. Joanne; Bowman, Sally
Based on their experience as designers and/or users of games as a learner-centered strategy in gerontology, geriatric, and aging-related courses and training programs, the authors note multiple advantages of using games as a learning tool, list six relevant games (including order information), and suggest a variety of ways games can be used. They…
Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur
Alexander Rösler; Tom Krause; Christina Niehuus; Wolfgang von Renteln-Kruse
A raising number of patients with osteosynthesis of the proximal femur and additional dementia will be seen in hospitals in the future due to demographic changes. There is an ongoing discussion, if and to what extent cognitive abilities do influence functional outcome in geriatric rehabilitation. We therefore compared 250 patients with osteosynthesis of the proximal femur of whom one half
Workshop for Key Staff of Geriatric Education Centers (4th, Houston, Texas, April 21-24, 1988). Workshop Report.
ERIC Educational Resources Information Center
Texas Consortium of Geriatric Education Centers, Houston.
This document contains an executive summary and the report of the workshop. An overview highlights major events and outcomes of the workshop. Major addresses and the staff development sessions that occurred at a workshop for key staff of geriatric education centers (GECs) are discussed. Summaries of presentations include the following: "Welcome,…
Examination of the Philadelphia Geriatric Morale Scale as a Subjective Quality-of-Life Measure in Elderly Hong Kong Chinese
ERIC Educational Resources Information Center
Wong, Eric; Woo, Jean; Hui, Elsie; Ho, Suzanne C.
Purpose: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. Design and Methods: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in…
Blanchette, Robert A.
GERIATRIC EDUCATION CENTER OldNews Center on Aging Summer Institute 2013 Dementia: The Disease of Our implications of dementia in our aging population, the focus of this year's Summer Institute was especially progression of the disease, but currently that's not possible. The four FDA-approved drugs for Alzheimer
Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit
Sodhi, Kanwalpreet; Singla, Manender Kumar; Shrivastava, Anupam; Bansal, Namita
Background: Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly. Objectives: Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age. Materials and Methods: A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group). Results: The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390–0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456–0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (? coefficient = 1.221, P = 0.000). Conclusion: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality. PMID:25538413
A photographic method to measure food item intake. Validation in geriatric institutions.
Pouyet, Virginie; Cuvelier, Gérard; Benattar, Linda; Giboreau, Agnčs
From both a clinical and research perspective, measuring food intake is an important issue in geriatric institutions. However, weighing food in this context can be complex, particularly when the items remaining on a plate (side dish, meat or fish and sauce) need to be weighed separately following consumption. A method based on photography that involves taking photographs after a meal to determine food intake consequently seems to be a good alternative. This method enables the storage of raw data so that unhurried analyses can be performed to distinguish the food items present in the images. Therefore, the aim of this paper was to validate a photographic method to measure food intake in terms of differentiating food item intake in the context of a geriatric institution. Sixty-six elderly residents took part in this study, which was performed in four French nursing homes. Four dishes of standardized portions were offered to the residents during 16 different lunchtimes. Three non-trained assessors then independently estimated both the total and specific food item intakes of the participants using images of their plates taken after the meal (photographic method) and a reference image of one plate taken before the meal. Total food intakes were also recorded by weighing the food. To test the reliability of the photographic method, agreements between different assessors and agreements among various estimates made by the same assessor were evaluated. To test the accuracy and specificity of this method, food intake estimates for the four dishes were compared with the food intakes determined using the weighed food method. To illustrate the added value of the photographic method, food consumption differences between the dishes were explained by investigating the intakes of specific food items. Although they were not specifically trained for this purpose, the results demonstrated that the assessor estimates agreed between assessors and among various estimates made by the same assessor. The results also revealed that the accuracy of this method was not dependent on the type of food studied, thus, the photographic method was not specific to a particular food type. Finally, the photographic method was able to provide more detailed data because it allowed differentiation between food item intakes. These findings clearly suggest that the photographic method is a valid and useful method to measure food intake in geriatric institutions. PMID:25261733
Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review
Background Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Methods Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Results Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Conclusions Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs. PMID:24112948
Makoto Higurashi; Kumiko Iijima; Hideoki Fukuoka; Yutaka Nakahori
Summary Ethical issues in the clinical practice of fetal medicine are discussed, largely from the point of view of early prenatal medicine. The discussion concentrates on several aspects including the time when human life begins, the pros and cons of fetal medicine, and ethical guidelines for fetal medicine. The emphasis is placed on the importance of informed consent and an
Genome Medicine 2009, 11::88 Correspondence BBrriiddggiinngg tthhee ggaapp bbeettwweeeenn Care Medicine and CRISMA laboratory, University of Pittsburgh School of Medicine, Scaife 602, 3550 Biotechnology Center, University of Torino, Via Nizza 52, I, 10126 Torino, Italy; 10Institutionen för Medicin
Faculty of Medicine and Medical Center (FM/AUBMC) #12;400 Faculty of Medicine and Medical Center (FM/AUBMC) Graduate Catalogue 201415 Faculty of Medicine and Medical Center (FM/AUBMC) Officers Vice President for Medical Affairs and the Raja N. Khuri Dean of the Faculty of Medicine Ziyad Ghazzal
Dance Medicine: Current Concepts
Clay Miller
Dance medicine has grown exponentially over the past 10 to 15 years and continues to grow every year as more former professional dancers and stu- dents of dance enter into the field of medicine. Dance medicine is part of the field of performing arts medicine, which specializes in evaluating and treat- ing performing artists such as musicians, dancers, actors\\/actresses, and
Traditional Chinese herbal medicine
You-Ping Zhu; Herman J. Woerdenbag
Herbal medicine, acupuncture and moxibustion, and massage are the three major constituent parts of traditional Chinese medicine. Although acupuncture is well known in many Western countries, Chinese herbal medicine, the most important part of traditional Chinese medicine, is less well known in the West. This article gives a brief introduction to the written history, theory, and teaching of Chinese herbal
An online guided e-journal exercise in pre-clerkship years: oxidative phosphorylation in brown adipose tissue.
Abali, Emine Ercikan; Phadtare, Sangita; Galt, Jim; Brodsky, Barbara
The rationale for this mandatory, guided online e-journal exercise is to foster the ability of students to independently read medical and scientific literature in a critical manner and to integrate journal reading with their basic science knowledge. After a lecture on oxidative phosphorylation, students were assigned to read an article on brown adipose tissue published in New England Journal of Medicine and were guided to analyze the article by answering online questions. After two iterations, student surveys about the project, its key pedagogical features, and ways to improve it suggest that the students perceived these exercises as active learning, which is clinically relevant and built on their course material. Furthermore, students agreed that the e-journal project was useful for learning how to read an article, for reviewing the material learned in class, and for promoting evidence-based medicine. This online e-journal exercise models some aspects students will experience as future physicians, where it is essential to keep up with literature and extract relevant information on a tight physician's schedule. This study demonstrated the usefulness of guided e-journal exercises as a simple effective active teaching tool for preclinical medical students, which can also be used for prehealth undergraduate programs. PMID:24599571
Population, environment, medicine and global sustainability.
Loraine, J A
The final two decades of this century see our planet in a highly perilous condition. This paper, after touching on the problem of nuclear proliferation, goes on to consider three other issues overpopulation, environmental depredation and the future of medical practice all of which are of high salience. The section on population concentrates on the time required for numbers to stabilize at two children per family. Europe is likely to attain stabilization before 2050, North America and the USSR by 2100. In the developing world South and East Asia could also be in balance by the beginning of the twenty-second century; but the situation in Africa vis-ŕ-vis population growth is much more serious and stabilization cannot be anticipated until about 2150. Destruction of life support systems on a massive scale continues, particularly in developing countries. Much of Asia, Africa and Latin America is riddled with soil erosion; expanding populations of humans and livestock are proving a notable catalyst to desertification; the 'firewood crisis' is deepening as slowly but surely the earth is being deforested. There is little convincing evidence that the major aims of the World Conservation Strategy maintenance and responsible utilization of essential ecological systems, preservation of genetic diversity are being obeyed anywhere in the world. In the more sustainable society of the future engineering medicine with its proclivity for resource depletion will be less attractive. Rather will the emphasis be on prevention and on attempting to delineate the environmental factors known to be responsible for an increasing number of diseases. The likely pattern of morbidity and mortality in the twenty-first century is discussed. Geriatric medicine will hold pride of place; the incidence of cancer will rise markedly, and as an increasing number of Third World nations undergo the process of development diseases, which up till now have mainly affected affluent technological societies, it will spread throughout the planet. PMID:6765304
Six decades of the chair of Internal Medicine at the Medical Faculty in Skopje.
Chakalaroski, K
(Full text is available at http://www.manu.edu.mk/prilozi). The chair of internal medicine in Republic of Macedonia was created in 1947. The Department of Internal Medicine (CIM) is the most numerous at Skopje's medical faculty (currently 56 members). According to the archive material from the first session of the Scientific Teaching Council of the Faculty of Medicine (17.03.1947), Mr Mario Krmpotic (Professor of Internal Medicine) was proposed as the first Director of the Internal Clinic (1947). For reasons unknown, Mr Krmpotic never came to Skopje to accept the post. As a consequence of this fact, the real founder of the CIM was the Russian Professor Alexandar Ignjatovski (1875-1955). Mr Ignjatovski was elected as the first Director of the Clinic for Internal Medicine in 1948 for a period of 4 years (1948-1952). At the same time, he was the first Chief of the CIM in Skopje (Macedonia). Dr D. Arsov was elected as the first Assistant Professor of Medicine in 1947, and second (and last) Director of the Clinic for Internal Medicine (1952-1974). For the same period (22 years) he was Head of the CIM. Dr D. Arsov sequentially and successively became first associated and then ordinary professor of medicine in the years 1951 and 1958. The regular activities of the CIM are as follows: 1) Undergraduate education for students (Clinical Investiga-tion, Internal Medicine, Clinical Pharmacy) in general medicine, dentistry, geriatrics, urgent and family medicine (ECKTS); Undergraduate educationfor nurses, speech therapists, physiotherapists, radiologists (high /three year/ nurses School, ECKTS); 2) Postgraduate education (candidates for specialisation in internal medicine, infectology, anaesthesiology, neurology and surgery; 3) Continual medical education (a traditional morning scientific meeting on Thursdays, 08h; weekly meetings of all internal medicine subspecialists); Scientific meetings, symposiums, congresses of former internal medicine associations (cardiology, pulmoallergology, gastroenterology, nephrology, haematology, rheumathology, endocriniology and toxicology); 4) Publishing activities in the national journals (Macedonian Medical Review, Journal of Macedonian Medical Science, Acta Physiologica, Medicus); 5) Decision-making: the Head of CIM regularly collaborates with the subspecialities of internal medicine by means of a coordinated body for all questions related to educational purposes in clinical investigation and internal medicine. Key words: Chair of internal medicine, development. PMID:23928802
Engaged teaching for engaged learning: sharing your passion for gerontology and geriatrics.
Karasik, Rona J
Gerontologists face a unique set of obstacles in attracting newcomers to the field. Despite demographic trends favorable to a wide range of employment opportunities and job security, aging is rarely top of mind for many students when it comes to career choices. For most gerontologists, aging is our passion. How do we share that passion with others who have yet to discover its interdisciplinary opportunities, or who may be held at bay by negative stereotypes of aging and older persons? This article explores various approaches to enhance engaged teaching and engaged learning that can help personalize and contextualize the field so that educators and students at all levels and disciplines can find their passion for gerontology and geriatrics. PMID:22490070
[Tolerance of influenza vaccination in the aged and the nursing staff in a geriatric hospital].
Odelin, M F; Pozzetto, B; Grattard, F; Benvenuto, V; Bonnevial, L
The tolerance of influenza vaccination (Vaxigrip, Pasteur-Mérieux) was evaluated during four consecutive years (1989-1992) in the geriatric hospital of Saint-Etienne from questionnaires concerning 327 vaccinations in the aged (group 1) and 88 vaccinations in members of the nursing staff (group 2). Minor local symptoms were the more common incidents, respectively for each group: blotch (9.8 and 21.6%), pain (9.2 and 47.7%), nodule (2.4 and 13.6%). Fatigue (4.0 vs 12.5%) and fever (6.1 vs 4.5%) were the more frequent among general symptoms, respectively in each group. No major vaccinal accident was recorded. These results underline that influenza vaccination is well tolerated, much more in aged people than in members of the nursing staff. PMID:7855762
Evolving Prehospital, Emergency Department, and "Inpatient" Management Models for Geriatric Emergencies
Carpenter, Christopher R.; Platts-Mills, Timothy F.
Alternative management methods are essential to ensure high quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols for case-finding and rapid diagnosis to support early condition-specific treatment for older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to look beyond the diagnosis to address the influence of other factors on the patient's health: isolation and depression; finances and transportation; and chronic medical conditions and polypharmacy. This review article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care. PMID:23177599
Respect your elders. Special considerations for EMS response to geriatric patients.
Widmeier, Keith
A variety of chronic pathologies often come along with the aging process and are experienced by many patients in late adulthood. EMS providers must be aware of the various challenges of transporting the geriatric population. And although an emphasis is often placed on the physical and medical issues associated with this population, it's also imperative to look at the whole picture to help prevent issues before they become an emegent problem. This includes being vigilant for elder abuse and neglect, as well as potential home hazards-including fall potentials and maintaining colder home temperatures-and dangerous cost-cutting measures, such as sharing medications. Prevention is key to helping older patients avoid potentially devastating situations, such as falls, medication errors and urban hyperthermia. But when those situations happen and providers are called to care for an older patient, compassion and demeanor are necessary to make this more vulnerable patient population comfortable and safe. PMID:24319883
New frontiers of cognitive rehabilitation in geriatric age: the Mozart Effect (ME).
Cacciafesta, M; Ettorre, E; Amici, A; Cicconetti, P; Martinelli, V; Linguanti, A; Baratta, A; Verrusio, W; Marigliano, V
The ME was described for the first time in 1993. Subsequently other studies with similar designs were performed. The present study, therefore, proposes: (i) to verify the existence of the benefits of exposure to music in elderly subjects with mild cognitive impairment (MCI), (ii) to explore whether it is possible to find any lasting improvement after training, conducted for a long period of time, with such musical pieces, in the measurable cognitive performances. The study we conducted showed that the ME is present in geriatric patients with MCI; the influence on spatial-temporal abilities remains constant in time if the stimulation is maintained. The continuation of our study will consist of increasing the number of individuals examined and in having them listen to music during the study of ECG rhythms and during the acquisition of cerebral functional magnetic resonance imaging (fMRI), and, at the same time, testing them by neuropsychometric methods. PMID:20138674
Geriatric performance on the Neurobehavioral Cognitive Status Examination (Cognistat). What is normal?
Macaulay, Caitlin; Battista, Matthew; Lebby, Paul C; Mueller, Jonathan
The Neurobehavioral Cognitive Status Examination (Cognistat) is a widely used cognitive screening measure that has been utilized in several clinical studies with a geriatric population. However, there has been relatively little normative research since its original publication. The objective of this study was to develop age-corrected norms for Cognistat. One hundred and fifty healthy participants aged 60-85 were recruited, all of whom spoke English fluently. Twenty-seven peoples met at least one exclusionary criterion and were therefore excluded. The participants were administered Cognistat along with measures of IQ, depression, alcohol usage, and activity level. Data were not normally distributed; therefore, analysis of these data was completed using descriptive statistics and the nonparametric bootstrapping technique. Study results provide age-corrected profiles that differ significantly from and extend the originally published norms. PMID:14591443
Practicing physician education in geriatrics: lessons learned from a train-the-trainer model.
Levine, Sharon A; Brett, Belle; Robinson, Bruce E; Stratos, Georgette A; Lascher, Steven M; Granville, Lisa; Goodwin, Carol; Dunn, Kathel; Barry, Patricia P
Evidence of poor performance in the evaluation and management of common geriatric conditions suggests the need for changing physician behavior in these areas. Traditional lecture-style continuing medical education (CME) has not been shown to be effective. Expert faculty initially trained 60 nonexpert peer educators to conduct small-group, learner-centered CME using tool kits on memory loss, incontinence, and depression. Peer educators presented 109 community-based sessions to 1,309 medical practitioners. Surveys were administered to community participants immediately and 6 months after a session. Evidence of effectiveness included statistically significant increases in self-reported knowledge, attitudes, and office-based practices on the target topics at the time of training and at the 6-month follow-up (P<.001) and two-thirds of respondents reporting continued use of three or more tools at 6 months. Participants reported that the interactive presentation aided their understanding of and ability to use the tool kits more than an off-the-shelf review (mean rating+/-standard deviation 4.1+/-0.71, with 1 = not at all and 5 = significantly). After the formal evaluation period, additional information about the project dynamics and tool kits was obtained through a small interview sample and an on-line survey, respectively. Receiving copies of the tool kits was an important factor in enabling educators to offer sessions. Barriers to offering sessions included finding time, an audience, and space. Findings suggest that modest positive changes in practice in relation to common geriatric problems can be achieved through peer-led, community-based sessions using principles of knowledge translation and evidence-based tool kits with materials for providers and patients. PMID:17661970
Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension
Akal, Ali; Ulas, Turgay; Goncu, Tugba; Karakas, Ekrem; Karakas, Omer; Kurnaz, Fatih; Boyaci, Fatima Nurefsan; Yilmaz, Omer Faruk; Bata, Abdulgafur; Yildiz, Sema
Background and Aim: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. Setting and Design: Designed as a cross-sectional study. Materials and Methods: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. Results: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). Conclusions: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy. PMID:25005192
Research strategies for geriatric evaluation and management: conference summary and recommendations.
Kramer, A; Deyo, R; Applegate, W; Meehan, S
In this paper, we present the consensus statement from a national conference on research priorities and methodologies for studying geriatric evaluation and management (GEM) programs. These conclusions, discussion points, and recommendations resulted from discussions of plenary papers, working group deliberations, and a final session in which findings were synthesized by the conference co-chairmen and presented to conference participants for final review. Major conclusions included: (1) The importance of linking geriatric evaluation with care management in future studies; (2) The need for multi-center trials of inpatient units to establish efficacy; (3) The importance of studying criteria for targeting GEM care on patients who are most likely to benefit; (4) The need for further developmental studies of outpatient GEM clinics; (5) The importance of assessing a range of outcomes including mortality, patient function, satisfaction, caregiver burden, and cost; and (6) The need to define more carefully the nature of the intervention that is being studied to aid in comparing and extrapolating findings. The following research priorities for GEMS were formulated based on the conference: (1) Within the VA health care system, a multi-site randomized trial of inpatient GEM units should be initiated; (2) Multi-site studies of inpatient GEM units and consultation teams linked to outpatient care should be initiated in non-VA settings; (3) Studies should identify the components of GEM that are most critical to outcome; (4) Studies should explore efficacy of GEM in settings that have not been well studied to date such as nursing homes; and (5) Studies are needed to test screening methods and targeting criteria for GEM in all settings. PMID:1885880
Serotonin Transporter Occupancy and the Functional Neuroanatomic Effects of Citalopram in Geriatric Depression
Smith, Gwenn S.; Kahn, Alan; Sacher, Julia; Rusjan, Pablo; van Eimeren, Thilo; Flint, Alastair; Wilson, Alan A.
Objectives The functional neuroanatomic changes associated with selective serotonin reuptake inhibitor (SSRI) treatment have been the focus of positron emission tomography (PET) studies of cerebral glucose metabolism in geriatric depression. Design To evaluate the underlying neurochemical mechanisms, the present study measured both cerebral glucose metabolism and serotonin transporter (SERT) availability prior to and during treatment with the SSRI, citalopram. It was hypothesized that SERT occupancy would be observed in cortical and limbic brain regions that have shown metabolic effects, as well as striatal and thalamic regions that have been implicated in prior studies in mid-life patients. Setting Psychiatric Outpatient Clinic. Participants Seven depressed patients who met DSM-IV criteria for current major depressive episode were enrolled. Intervention Patients underwent a twelve week open-label trial of the SSRI, citalopram. Measurements Patients underwent high resolution research tomography (HRRT) PET scans to measure changes in cerebral glucose metabolism and SERT occupancy by citalopram treatment (after 8–10 weeks of treatment). Results Three different tracer kinetic models were applied to the [11C]-DASB region of interest data and yielded similar results of an average of greater than 70% SERT occupancy in the striatum and thalamus during citalopram treatment. Voxel-wise analyses showed significant SERT occupancy in these regions, as well as cortical (e.g. anterior cingulate, superior and middle frontal, precuneus, and limbic (parahippocampal gyrus) areas that also showed reductions in glucose metabolism. Conclusions The findings suggest that cortical and limbic SERT occupancy may be an underlying mechanism for the regional cerebral metabolic effects of citalopram in geriatric depression. PMID:21841458