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Sample records for geriatric medicine clerkship

  1. Pre-Clerkship Observerships to Increase Early Exposure to Geriatric Medicine

    PubMed Central

    You, Peng; Leung, Marie; Xu, Victoria Y. Y.; Astell, Alexander; Gill, Sudeep S.; Gibson, Michelle; Frank, Christopher

    2015-01-01

    Background and Purpose To foster interest in geriatric care, the Queen’s Geriatrics Interest Group (QGIG) collaborated with the Division of Geriatric Medicine to arrange a Geriatrics Pre-Clerkship Observership Program. Methods Forty-two pre-clerkship medical students participated in the program between October 2013 and May 2014. Participants were paired with a resident and/or attending physician for a four-hour weekend observership on an inpatient geriatric rehabilitation unit. The program was assessed using: (1) internally developed Likert scales assessing student’s experiences and interest in geriatric medicine before and after the observership; (2) University of California Los Angeles–Geriatric Attitudes Scale (UCLA-GAS); and (3) narrative feedback. Results All participants found the process of setting up the observership easy. Some 72.7% described the observership experience as leading to positive changes in their attitude toward geriatric medicine and 54.5% felt that it stimulated their interest in the specialty. No statistically significant change in UCLA–GAS scores was detected (mean score pre- versus post-observership: 3.5 ± 0.5 versus 3.7 ± 0.4; p=.35). All participants agreed that the program should continue, and 90% stated that they would participate again. Conclusions The observership program was positively received by students. Structured pre-clerkship observerships may be a feasible method for increasing exposure to geriatric medicine. PMID:26740831

  2. Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation

    PubMed Central

    Diachun, Laura; Charise, Andrea; Goldszmidt, Mark; Hui, Yin; Lingard, Lorelei

    2014-01-01

    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

  3. Responses of Fourth-Year Medical Students to a Required Clerkship in Geriatrics.

    ERIC Educational Resources Information Center

    Murden, Robert A.; And Others

    1986-01-01

    Students at the Mount Sinai School of Medicine of the City University of New York taking a required clinical clerkship in geriatrics were surveyed before and after the clerkship on their knowledge of geriatrics, attitudes toward the elderly, and evaluation of the rotation. (Author/MLW)

  4. 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.

    2013-01-01

    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

  5. 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.

    2013-01-01

    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…

  6. An innovative family medicine clerkship.

    PubMed

    Smith, S R; MacLeod, N M

    1981-10-01

    A clinical clerkship in family medicine at Brown University has been developed utilizing many innovative educational modalities. These include games, simulations, group problem solving, research projects, videotaping, case presentations, field trips, sensitivity sessions, computer assisted instruction, patient management problems, slide-tape shows, and direct clinical experiences. These modalities are described together with a new approach to evaluation. Students' evaluations of the clerkship have been excellent, providing evidence that this clerkship offers a model of learning that is both effective and enjoyable. PMID:7276876

  7. Teaching Prevention in Internal Medicine Clerkships.

    ERIC Educational Resources Information Center

    Kinsinger, Linda

    2000-01-01

    Reviews the rationale for including prevention in the clinical medicine clerkship. Summarizes current guidelines, presents examples of curricula in several medical schools, and proposes a future direction that stresses integrating teaching preventive medicine into internal medicine clerkships and across the entire four-year medical curriculum. (DB)

  8. A Cost-Effective Emergency Medicine Clerkship.

    ERIC Educational Resources Information Center

    Shesser, Robert; And Others

    1985-01-01

    Programs in emergency medicine are expected to become increasingly organized with the development of emergency medicine teaching faculties. A clerkship design with clinical instruction, classroom instruction, and evaluation is described. (Author/MLW)

  9. Model Geriatric Clerkship for Physician Assistant Students: The Continuum of Elder Care. Manual for Physician Assistant Programs.

    ERIC Educational Resources Information Center

    Yeo, Gwen; Tully, Donna

    This manual is intended to acquaint the faculty of physician assistant (PA) training programs with a model geriatric clerkship and to assist them in the process in implementing a similar clerkship. A detailed outline of the curriculum goals of a geriatric clerkship is included. The next section contains curriculum units on the following topics:…

  10. A Multidisciplinary Clerkship in Emergency Medicine.

    ERIC Educational Resources Information Center

    And Others; Marshall, Carter L.

    1979-01-01

    At the New Jersey Medical School, an obligatory, multidisciplinary, fourth-year emergency medicine clerkship requires ambulance duty, emergency room rotation, medical specialty lectures, and a cardiac life support providers course. Particular problems associated with multidisciplinary courses are discussed. (Author/JMD)

  11. Ultrasound Training in the Emergency Medicine Clerkship

    PubMed Central

    Favot, Mark; Courage, Cheryl; Mantouffel, Jacob; Amponsah, David

    2015-01-01

    Introduction The curriculum in most emergency medicine (EM) clerkships includes very little formalized training in point-of-care ultrasound. Medical schools have begun to implement ultrasound training in the pre-clinical curriculum, and the EM clerkship is an appropriate place to build upon this training. The objectives are (1) to evaluate the effectiveness of implementing a focused ultrasound curriculum within an established EM clerkship and (2) to obtain feedback from medical students regarding the program. Methods We conducted a prospective cohort study of medical students during an EM clerkship year from July 1, 2011, to June 30, 2012. Participants included fourth-year medical students (n=45) enrolled in the EM clerkship at our institution. The students underwent a structured program focused on the focused assessment with sonography for trauma exam and ultrasound-guided vascular access. At the conclusion of the rotation, they took a 10-item multiple choice test assessing knowledge and image interpretation skills. A cohort of EM residents (n=20) also took the multiple choice test but did not participate in the training with the students. We used an independent samples t-test to examine differences in test scores between the groups. Results The medical students in the ultrasound training program scored significantly higher on the multiple-choice test than the EM residents, t(63)=2.3, p<0.05. The feedback from the students indicated that 82.8% were using ultrasound on their current rotations and the majority (55.2%) felt that the one-on-one scanning shift was the most valuable aspect of the curriculum. Discussion Our study demonstrates support for an ultrasound training program for medical students in the EM clerkship. After completing the training, students were able to perform similarly to EM residents on a knowledge-based exam. PMID:26594295

  12. Development and Evaluation of a Longitudinal Case-Based Learning (CBL) Experience for a Geriatric Medicine Rotation

    ERIC Educational Resources Information Center

    Struck, Bryan D.; Teasdale, Thomas A.

    2008-01-01

    The DWR Department of Geriatric Medicine at OUHSC and the OKC VA Medical Center began a mandatory third-year geriatric medicine clerkship in 2003. As part of the didactic sessions, the Department created a longitudinal Case-Based Learning (CBL) experience. The purpose of this paper is to describe the CBL experience, report student satisfaction…

  13. A community medicine clerkship on the Navajo Indian reservation.

    PubMed

    Rogers, K D; Coulehan, J L

    1984-12-01

    An elective clerkship in community medicine for medical students has been conducted for 16 years on the Navajo Indian reservation. An important part of the clerkship is a project in which most students select a health problem which they investigate using epidemiological methods of assessment and for which they seek a solution. The requisites for the projects are that real health problems are involved, scientifically sound methods are used, usable information is provided, and data collection can be completed within the clerkship tenure. Topics for the projects are selected jointly by the students and the faculty members from several general subject areas; this allows the work of individual students to be carried out as independent subprojects of larger projects, and this, in turn, produces more information about and has more impact on the problems addressed. Other clerkship objectives also are achieved through investigative projects that may involve students in planning, organization, and evaluation of health care and in public health practice. PMID:6502662

  14. A Comparison of Students' Clinical Experience in Family Medicine and Traditional Clerkships.

    ERIC Educational Resources Information Center

    Parkerson, George R., Jr.; And Others

    1984-01-01

    Experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships was compared with the experience on a family medicine clerkship. The family medicine clerkship offered the most experience with circulatory, respiratory, digestive, neurological, musculoskeletal, and skin problems and with…

  15. [Review in geriatric medicine].

    PubMed

    Jabri, A; Rodondi, A; Eyer, S; Doser, N; Monod, S; Gold, G; Büla, C; Rochat, S

    2011-01-12

    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

  16. [Review in geriatric medicine].

    PubMed

    Monod, Stéfanie; Rochat, Stéphane; Gold, Gabriel; Büla, Christophe

    2009-01-01

    Several studies published in 2008 underline the potential danger of polymedication in older patients and propose indicators to identify those at higher risk for adverse events. A study from Oregon highlighted the difficulties to diagnose depression in patients, especially older ones, who made a request for assisted suicide. The HYVET study demonstrated that treatment of hypertension is beneficial even in some very old persons. A meta-analysis confirmed the benefits from community-based geriatric interventional programs, in particular when targeting older individuals recently discharged from the hospital. Finally, mixed results were observed in the field of dementia. PMID:19216320

  17. Community Medicine Clerkships in an Applied Research Setting

    ERIC Educational Resources Information Center

    Stewart, Michael M.; And Others

    1977-01-01

    A four-week clerkship in community medicine is a requirement for all third-year students at the Mount Sinai School of Medicine. An important feature of the program is the wide variety of settings available to students, including the City Hospital Center at Elmhurst, which is described. (LBH)

  18. ENT Experience in a Family Medicine Clerkship: Is There Enough?

    ERIC Educational Resources Information Center

    O'Hara, Brenda S.; Saywell, Robert M., Jr.; Zollinger, Terrell W.; Smith, Christopher P.; Burba, Jennifer L.; Stopperich, David M.

    2000-01-01

    Used patient encounter records completed by 445 medical students to determine whether a family medicine clerkship offered enough experience in ear, nose, and throat (ENT) conditions. Results, which were used for curriculum development, suggest that these students were receiving sufficient opportunities for some areas of ENT practice, but not for…

  19. Impact of a Required Family Medicine Clerkship on Medical Students' Attitudes about Primary Care.

    ERIC Educational Resources Information Center

    Duerson, Margaret C.; And Others

    1989-01-01

    A survey of 314 medical students before and after a required third-year internal medicine clerkship found differences between students choosing primary care and subspecialties, while undecided students shifted between those groups on several items. Results suggest the clerkship may affect students' image of primary care. (Author/MSE)

  20. Organizing Family Medicine Geriatric Care

    PubMed Central

    Hayes, Vonda M.

    1989-01-01

    This article, written from the perceptive of a practising community physician, examines the servies available in the field of geriatric care at the present time. It suggests integration and co-ordination of existing facilities to maximize the current potential. It also considers the economic, geographical, and ethical concerns relating to geriatric care. It is a call for family physicians to co-ordinate their efforts in a multidisciplinary mode to ensure that our elderly are maintained in a comfortable caring atmosphere that encourages their maximum independence. PMID:21248994

  1. Research Methods Priorities in Geriatric Palliative Medicine

    PubMed Central

    2013-01-01

    Abstract Continuing the momentum of geriatric palliative medicine research achieved during the past decade requires a focus on research methods priorities that span the continuum of research from small pilot studies testing new interventions to large multisite studies evaluating implementation of proven interventions and models of care. Each phase of this continuum presents unique challenges for investigators who are designing, conducting, and reporting results of these scientific endeavors. The goal of this article is to describe the top priorities in research methods for the field of geriatric palliative medicine that will enable the field to rapidly respond to the changing landscape of health care policy and quality improvement initiatives. PMID:23777330

  2. Research methods priorities in geriatric palliative medicine.

    PubMed

    Aldridge Carlson, Melissa D

    2013-08-01

    Continuing the momentum of geriatric palliative medicine research achieved during the past decade requires a focus on research methods priorities that span the continuum of research from small pilot studies testing new interventions to large multisite studies evaluating implementation of proven interventions and models of care. Each phase of this continuum presents unique challenges for investigators who are designing, conducting, and reporting results of these scientific endeavors. The goal of this article is to describe the top priorities in research methods for the field of geriatric palliative medicine that will enable the field to rapidly respond to the changing landscape of health care policy and quality improvement initiatives. PMID:23777330

  3. Development of an Internal Medicine Clerkship by a Department of Medicine.

    ERIC Educational Resources Information Center

    Noel, Gordon L.

    1983-01-01

    The creation and evolution of an internal medicine clerkship in three large teaching hospitals undergoing transition from affiliated hospitals to the university hospitals of a new medical school, the Uniformed Services University of the Health Sciences, is summarized. (Author/MLW)

  4. ETHICS IN GERIATRIC MEDICINE RESEARCH

    PubMed Central

    İlgili, Önder; Arda, Berna; Munir, Kerim

    2014-01-01

    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

  5. Undergraduate Teaching in Geriatric Medicine: The Role of National Curricula

    ERIC Educational Resources Information Center

    Blundell, Adrian; Gordon, Adam; Gladman, John; Masud, Tahir

    2009-01-01

    There has been recent international concern that the teaching of geriatrics may be in decline. Research has suggested that support for geriatrics in national undergraduate curricula is the key to effective delivery of teaching in the specialty. We set out to determine the geriatric medicine content in the U.K. generic curriculum, reviewing this in…

  6. Geriatric management in medieval Persian medicine

    PubMed Central

    Emami, Morteza; Sadeghpour, Omid; Zarshenas, Mohammad M.

    2013-01-01

    In Iran, a large group of patients are elderly people and they intend to have natural remedies as treatment. These remedies are rooted in historical of Persian and humoral medicine with a backbone of more than 1000 years. The current study was conducted to draw together medieval pharmacological information related to geriatric medicine from some of the most often manuscripts of traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plants through a search of the PubMed, Scopus and Google Scholar databases. In the medieval Persian documents, digestible and a small amount of food such as chicken broth, honey, fig and plum at frequent intervals as well as body massage and morning unctioning are highly recommended. In the field of pharmacotherapy, 35 herbs related to 25 families were identified. Plants were classified as tonic, anti-aging, appetizer, memory and mood enhancer, topical analgesic and laxative as well as health improvement agents. Other than historical elucidation, this paper presents medical and pharmacological approaches that medieval Persian practitioners applied to deal with geriatric complications. PMID:24381461

  7. Simulation in Medical Student Education: Survey of Clerkship Directors in Emergency Medicine

    PubMed Central

    Heitz, Corey; Eyck, Raymond Ten; Smith, Michael; Fitch, Michael

    2011-01-01

    Introduction The objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulation-based programs; and (3) educational advances to meet these challenges. Methods We solicited members of the Clerkship Directors in Emergency Medicine (CDEM) e-mail list to complete a Web-based survey addressing the use of simulation in both EM clerkships and preclinical EM curricula. Survey elements addressed the nature of the undergraduate EM clerkship and utilization of simulation, types of technology, and barriers to increased use in each setting. Results CDEM members representing 60 EM programs on the list (80%) responded. Sixty-seven percent of EM clerkships are in the fourth year of medical school only and 45% are required. Fewer than 25% of clerkship core curriculum hours incorporate simulation. The simulation modalities used most frequently were high-fidelity models (79%), task trainers (55%), and low-fidelity models (30%). Respondents identified limited faculty time (88.7%) and clerkship hours (47.2%) as the main barriers to implementing simulation training in EM clerkships. Financial resources, faculty time, and the volume of students were the main barriers to additional simulation in preclinical years. Conclusion A focused, stepwise application of simulation to medical student EM curricula can help optimize the ratio of student benefit to faculty time. Limited time in the curriculum can be addressed by replacing existing material with simulation-based modules for those subjects better suited to simulation. Faculty can use hybrid approaches in the preclinical years to combine simulation with classroom settings for either small or large groups to more actively engage learners while minimizing identified barriers. PMID:22224137

  8. 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

    2006-01-01

    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…

  9. 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

    2006-01-01

    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

  10. Meeting the challenge of evidence-based medicine in the family medicine clerkship: closing the loop from academics to office.

    PubMed

    Cavanaugh, Susan K; Calabretta, Nancy

    2013-01-01

    An EBM Seminar and POEM project was developed to teach evidence-based medicine in a family medicine clerkship. The seminar focused on the application of preclinical coursework in biostatistics and epidemiology to the clinical third year. POEM projects involved answering clinical questions, derived from patient cases in the family medicine offices, with best available evidence. These questions and answers were archived in a wiki which was made available to the institution's family medicine physicians. Selected POEMs were also published in the in-house family medicine newsletter. The POEM projects evolved from an educational exercise for medical students to a valuable repository of evidence for clinicians. PMID:23607466

  11. Does the Concept of the “Flipped Classroom” Extend to the Emergency Medicine Clinical Clerkship?

    PubMed Central

    Heitz, Corey; Prusakowski, Melanie; Willis, George; Franck, Christopher

    2015-01-01

    Introduction Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a “flipped classroom” model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Methods Students at two institutions were randomized to complete two of four selected EM clerkship topics in a “flipped fashion,” and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students’ discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Results Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol. Conclusion Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an attempt at chief-complaint-focused learning during a shift did not result in improvements in performance on a multiple-choice assessment of knowledge; however, one third of participants did not adhere strictly to the protocol. Future investigations should ensure performance of pre-assigned learning as well as clinical experiences, and consider alternate measures of knowledge. PMID:26594277

  12. Medicine Clerkship Implementation in a Hospitalist Group: Curricular Innovation and Review

    PubMed Central

    Carter, William J.

    2016-01-01

    Background: In 2008, the Department of Hospital Medicine at Ochsner Clinic Foundation in New Orleans, LA, began training its own students for the first time as a result of the partnership between our institution and the University of Queensland (UQ) in Brisbane, Australia, that established a global medical school. The Department of Hospital Medicine is responsible for the Medicine clerkship for third-year medical students. We have 5 resident teams at the main hospital in the system, but the majority of our hospitalists work alone. Because of staffing issues, we have had to change our mentality from having teaching hospitalists and nonteaching hospitalists to viewing all hospitalists as potential educators. Methods: The department has slowly increased the number of students in the Medicine clerkship each year with the goal of training 120 third-year students in the New Orleans area in 2016. The students in the Medicine clerkship will be divided into five 8-week rotations, allowing for 25 students to be trained at one time. Results: The UQ curriculum is similar to that of most 4-year American schools, but some differences in methods, such as a heavy emphasis on bedside instruction and oral summative assessments, are novel to us. These differences have provided our department with new goals for professional and instructor development. For the actual instruction, we pair students one on one with hospitalists and also assign them to resident teams. Student placement has been a challenge, but we are making improvements as we gain experience and explore opportunities for placement at our community hospitals. Conclusion: Our arrangement may be adapted to other institutions in the future as the number of students increases and the availability of resident teachers becomes more difficult nationwide. PMID:27046406

  13. Improving recruitment into geriatric medicine in Canada: Findings and recommendations from the geriatric recruitment issues study.

    PubMed

    Torrible, Susan J; Diachun, Laura L; Rolfson, Darryl B; Dumbrell, Andrea C; Hogan, David B

    2006-09-01

    As the number of Canadians aged 65 and older continues to increase, declining recruitment into geriatric medicine (GM) raises concerns about the future viability of this medical subspecialty. To develop effective strategies to attract more GM trainees into the field, it is necessary to understand how medical students, residents, GM trainees, and specialists make career choices. The Geriatric Recruitment Issues Study (GRIST) was designed to assess specific methods that could be used to improve recruitment into geriatrics in Canada. Between November 2002 and January 2003, 530 participants were invited to complete the GRIST survey (117 Canadian geriatricians, 12 GM trainees, 96 internal medicine residents, and 305 senior medical students). Two hundred fifty-three surveys (47.7%) were completed and returned (from 54 participating geriatricians, 9 GM trainees, 50 internal medicine residents, and 140 senior medical students). The survey asked respondents to rate factors influencing their choice of medical career, the attractiveness of GM, and the anticipated effectiveness of potential recruitment strategies. Although feedback varied across the four groups on these issues, consistencies were observed between medical students and residents and between GM trainees and geriatricians. All groups agreed that role modeling was effective and that summer student research programs were an ineffective recruitment strategy. Based on the GRIST findings, this article proposes six recommendations for improving recruitment into Canadian geriatric medicine training programs. PMID:16970658

  14. Geritalk: communication skills training for geriatric and palliative medicine fellows.

    PubMed

    Kelley, Amy S; Back, Anthony L; Arnold, Robert M; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; Smith, Cardinale B; O'Neill, Lynn B

    2012-02-01

    Expert communication is essential to high-quality care for older patients with serious illness. Although the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatric and palliative medicine fellows is often inadequate or unavailable. The current study drew upon the educational principles and format of an evidence-based, interactive teaching method to develop an intensive communication skills training course designed specifically to address the common communication challenges that geriatric and palliative medicine fellows face. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques before the course. Geriatric and palliative medicine fellows were recruited to participate in the course and 100% (n = 18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on a 5-point scale). After the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, P < .001). Two months after the course, fellows reported a high level of sustained skills practice (mean 4.3 on 5-point scale). In sum, the intensive communication skills program, customized for the specific needs of geriatric and palliative medicine fellows, improved fellows' self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. PMID:22211768

  15. Geritalk: Communication Skills Training for Geriatrics and Palliative Medicine Fellows

    PubMed Central

    Kelley, Amy S.; Back, Anthony L.; Arnold, Robert M.; Goldberg, Gabrielle R.; Lim, Betty B.; Litrivis, Evgenia; Smith, Cardinale B.; ONeill, Lynn B.

    2011-01-01

    Expert communication is essential to high quality care for older patients with serious illness. While the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatrics and palliative medicine fellows is often inadequate or unavailable. We drew upon the educational principles and format of an evidence-based, interactive teaching method, to develop an intensive communication skills training course designed specifically to address the common communication challenges faced by geriatrics and palliative medicine fellows. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques prior to the course. Geriatrics and palliative medicine fellows were recruited to participate in the course and 100% (n=18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on 5-point scale). Compared to before the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, p<0.01). Two months after the course, fellows reported a high level of sustained skills practice (mean 4.3 on 5-point scale). In sum, the intensive communication skills program, tailored to the specific needs of geriatrics and palliative medicine fellows, improved fellows self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. PMID:22211768

  16. Culture Competence in the Training of Geriatric Medicine Fellows

    ERIC Educational Resources Information Center

    Tanabe, Marianne K. G.

    2007-01-01

    With the aging and diversifying of the elder population in the United States, there is a pressing need for an organized and effective curriculum in cultural competence. The Accreditation Council for Graduate Medical Education (ACGME) requires that the curriculum for Geriatric Medicine Fellowship training include cultural competency training.…

  17. Smoking Assessment and Cessation Skills in the Inpatient Medicine Clerkship.

    ERIC Educational Resources Information Center

    Hull, Alan L.; Kleinhenz, Mary Ellen

    1990-01-01

    Analysis of 61 inpatient medical writeups by 23 third year medicine clerks found smoking history notations in 74 percent but quantification of exposure much less commonly. None detailed patient addiction or willingness to quit, or included smoking cessation in the patient plan. Students' smoking assessment and cessation skills are seen as poorly…

  18. Smoking Assessment and Cessation Skills in the Inpatient Medicine Clerkship.

    ERIC Educational Resources Information Center

    Hull, Alan L.; Kleinhenz, Mary Ellen

    1990-01-01

    Analysis of 61 inpatient medical writeups by 23 third year medicine clerks found smoking history notations in 74 percent but quantification of exposure much less commonly. None detailed patient addiction or willingness to quit, or included smoking cessation in the patient plan. Students' smoking assessment and cessation skills are seen as poorly

  19. The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine.

    PubMed

    Mold, J W; Mehr, D R; Kvale, J N; Reed, R L

    1995-04-01

    The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task. PMID:7797001

  20. Impact of family medicine clerkships in undergraduate medical education: a systematic review

    PubMed Central

    Turkeshi, Eralda; Michels, Nele R; Hendrickx, Kristin; Remmen, Roy

    2015-01-01

    Objective Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. Data sources Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. Review methods Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied. Results Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients. Conclusions Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools. PMID:26243553

  1. Assessing Knowledge Base on Geriatric Competencies for Emergency Medicine Residents

    PubMed Central

    Hogan, Teresita M.; Hansoti, Bhakti; Chan, Shu B.

    2014-01-01

    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

  2. [Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013].

    PubMed

    Singler, K; Stuck, A E; Masud, T; Goeldlin, A; Roller, R E

    2014-11-01

    Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue. PMID:25217287

  3. A conceptual model for a geriatric fellowship in podiatric medicine.

    PubMed

    Helfand, A E

    2000-06-01

    The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public. PMID:10881464

  4. Alternative medicines for the geriatric veterinary patient.

    PubMed

    Kidd, J Randy

    2012-07-01

    Over the past several decades, alternative medicines have gained in popularity for use in both humans and animals. While they are not without controversy, client interest and usage dictate that even those practitioners who do not want to practice any of them in their own hospital or clinic should at least be aware of their common use, safety, and efficacy. The author briefly discusses some of the more popular alternative medicines—acupuncture, chiropractic, herbal, homeopathic, and flower essences—with respect to some of the basics that every practitioner should know about them. PMID:22720815

  5. The Glass Is Half Full: Geriatric Precepting Encounters in Family Medicine

    ERIC Educational Resources Information Center

    Rollins, Lisa K.; Martirosian, Tovia; Gazewood, John D.

    2009-01-01

    Approximately 19% to 20% of all family medicine office visits involve care to patients older than age 65, yet limited research addresses family medicine geriatric education in the outpatient setting. This study explored how geriatric content is incorporated into resident/attending precepting encounters, using direct observation. An observer…

  6. Teaching behavior change concepts and skills during the third-year medicine clerkship.

    PubMed

    Moser, Eileen M; Stagnaro-Green, Alex

    2009-07-01

    Risky health behaviors and social factors are linked to half of all causes of morbidity and mortality in the United States. Physicians report lack of training as one of the barriers to providing behavior change counseling. Formal behavior change curricula are infrequent in medical schools, and where they are available, they are often isolated from clinical experiences or presented through a limited approach. The authors developed the Health Beliefs and Behavior (HBB) course at University of Medicine and Dentistry-New Jersey Medical School (UMDNJ-NJMS) to teach the impact of unhealthy behaviors on health and wellness, to broaden students' understanding of the many factors that affect behavior, and to give medical students tools to facilitate health behavior change in patients. To the authors' knowledge, this is the only comprehensive, clinically integrated course on health behavior change in a U.S. medical school.The authors intercalated the 60-hour HBB course in the four-week, third-year internal medicine clerkship ambulatory block. Thus, students practice learned techniques in both the ambulatory and classroom settings, and they gain insight into health behavior by applying learned health models to patients and engaging in experiential exercises. Course components stress the biopsychosocial and patient-centered approach. The authors measure the impact of the course through student surveys. Third-year medical students at UMDNJ-NJMS who have completed the HBB course report enhanced understanding of the principles of behavior change and improved ability to perform behavior change counseling. PMID:19550175

  7. Preventive geriatrics: an overview from traditional Chinese medicine.

    PubMed

    Zhou, D H

    1982-01-01

    The philosophical tradition of Chinese geriatrics contains a strong preventive element closely tied to the concept of a balanced man-nature relationship and body-mind relationship. It has been emphasized that a sound mind in a sound body is essential to longevity. Moderation in physical and emotional activities is encouraged. There have been a number of approaches to longevity in traditional Chinese medicine. The preventive value of Tai Chi Chuan (a gentle "spiritual" exercise), Chi Kung (a combination of breathing exercise, relaxation and meditation), acupressure and moxibustion on the point of Chu San Li, and tonic herbal medicines like ginseng is discussed in this article. These are regarded to be helpful in improving the general health of the elderly and in promoting longevity. PMID:6763844

  8. An operational model for teaching geriatric medicine in a family practice residency program.

    PubMed

    Kelly, J T; Garetz, F; Hanson, R G; Houge, D; Spencer, D; Ciriacy, E W

    1977-06-01

    Increased concern for our aging population has necessitated an evaluation of the role of gerontology and geriatric medicine in both undergraduate and graduate medical education programs. The instructional model developed for the Family Practice Residency Program at the University of Minnesota Medical School emphasizes removing barriers to health care for the aged and modifying attitudes of physicians toward normal aging. Three general components make up the Geriatric Medicine Program: (1) clinical rotations in geriatric medicine in ambulatory residential facilities, in multilevel long-term care facilities, and in an acute care hospital; (2) geriatric case conferences; and (3) a seminar in gerontology and geriatric medicine. Evaluation of these components by the residents indicates a high degree of satisfaction with the experience and belief in its applicability to future practice. PMID:874437

  9. Correlation of the National Emergency Medicine M4 Clerkship Examination with USMLE Examination Performance

    PubMed Central

    Lawson, Luan E.; Musick, Davis; Brewer, Kori

    2015-01-01

    Introduction Assessment of medical students’ knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students’ strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores. Methods From August 2011 to April 2013, average National EM M4 examination scores of fourth-year medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores. Results 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28–0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25–0.65]). Students scoring below the median on the national EM M4 exam also scored well below their colleagues on USMLE exams. Conclusion The moderate correlation of the national EM M4 examination and USMLE Step 1 and Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as an effective means of assessing medical knowledge for fourth-year medical students. Identification of students scoring lower on standardized exams allows for effective remedial efforts to be undertaken throughout the medical education process. PMID:26759671

  10. Basic Geriatrics Knowledge Among Internal Medicine Trainees in a Teaching Hospital in Saudi Arabia.

    PubMed

    Al-Aama, Tareef

    2016-06-01

    To assess the basic knowledge of medical trainees, in the absence of a structured geriatrics curriculum, around a variety of geriatric medicine components that are considered essential for the care of the rapidly increasing elderly population. Eighty-three trainees at different levels of training in internal medicine were asked about a variety of common geriatric conditions. Those included: delirium, falls, geriatric syndromes, pain, cognitive impairment, and medications. The trainees' knowledge about common geriatric condition was overall poor. The most pronounced deficits included: the lack of familiarity in diagnosing geriatric syndromes (63 %) or managing them (67 %), the underestimation of the prevalence of delirium (49 %), and the tendency to undertreat pain (64 %). Poor familiarity with polypharmacy and its impact, as well as inappropriate prescription practices in the elderly were also observed. In the absence of a structured geriatric medicine curriculum, internal medicine trainees' knowledge about important geriatric conditions is poor, even if their internal medicine knowledge is overall adequate. This would translate into suboptimal care for this vulnerable and rapidly expanding segment of the population. PMID:27033085

  11. Development and assessment of a pediatric emergency medicine simulation and skills rotation: meeting the demands of a large pediatric clerkship

    PubMed Central

    Fielder, Elaine K.; Lemke, Daniel S.; Doughty, Cara B.; Hsu, Deborah C.; Middleman, Amy B.

    2015-01-01

    Objective To implement a curriculum using simulation and skills training to augment a Pediatric Emergency Medicine (PEM) rotation within a pediatric clerkship. Background PEM faculty are often challenged with a high learner to teacher ratio in a chaotic clinical setting. This challenge was heightened when our pediatric clerkship's traditional 1-week PEM rotation (consisting of 4 students completing four 8-hour ED shifts/week) expanded to 8 students every 2 weeks. We sought to meet this challenge by integrating simulation-based education into the rotation. Methods Clerkship students from March to June 2012 completed our traditional rotation. Students between July and October 2012 completed the new PEM-SIM curriculum with 19 hours ED shifts/week and 16 hours/week of simulation/skills training. Pre/post-tests evaluated 1) medical management/procedural comfort (five-point Likert scale); and 2) PEM knowledge (15 multiple-choice questions). Results One hundred and nine students completed the study (48 traditional, 61 PEM-SIM). Improvement in comfort was significantly higher for the PEM-SIM group than the traditional group for 6 of 8 (75%) medical management items (p<0.05) and 3 of 7 (43%) procedures, including fracture splinting, lumbar puncture, and abscess incision/drainage (p<0.05). PEM-SIM students had significantly more improvement in mean knowledge compared to the traditional group (p<0.001). Conclusions We have successfully integrated 16 hours/week of faculty-facilitated simulation-based education into a PEM rotation within our clerkship. This curriculum is beneficial in clinical settings with high learner to teacher ratios and when patient care experiences alone are insufficient for all students to meet rotation objectives. PMID:26626927

  12. Geriatric Medicine Training for Family Practice Residents in the 21st Century: A Report from the Residency Assistance Program/Hartford Geriatrics Initiative.

    ERIC Educational Resources Information Center

    Warshaw, Gregg; Murphy, John; Buehler, James; Singleton, Stacy

    2003-01-01

    Summarizes the initial results of the regional geriatric medicine curriculum retreats for family practice residency directors provided as part of the American Academy of Family Physicians multi-part project to improve the amount and quality of geriatric medicine education received by family practice residents. (EV)

  13. First Year Medical Students' Knowledge, Attitudes, and Interest in Geriatric Medicine

    ERIC Educational Resources Information Center

    Lu, Wei-Hsin; Hoffman, Kimberly G.; Hosokawa, Michael C.; Gray, M. Peggy; Zweig, Steven C.

    2010-01-01

    The purpose of this study was to examine the impact of an extracurricular geriatric program on medical students' knowledge of, and attitudes toward, the elderly and their interest in studying geriatric medicine. The participants were first-year medical students (n = 137) who joined the Senior Teacher Education Partnership (STEP) program that…

  14. Relating Medical Students' Knowledge, Attitudes, and Experience to an Interest in Geriatric Medicine

    ERIC Educational Resources Information Center

    Fitzgerald, James T.; Wray, Linda A.; Halter, Jeffrey B.; Williams, Brent C.; Supiano, Mark A.

    2003-01-01

    Purpose: This study examined medical students' interest in geriatrics: Are knowledge, positive attitudes, and prior experience with older adults associated with an interest in geriatric medicine? Design and Methods: Entering University of Michigan medical students completed three surveys: the Revised Facts on Aging Quiz, the University of…

  15. 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.

    2009-01-01

    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

  16. 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.

    2009-01-01

    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…

  17. Mortality meetings in geriatric medicine: strategies for improvement

    PubMed Central

    Dunbar, Joanne; George, James

    2015-01-01

    A large proportion of patients who die in hospital will be under the care of geriatric medicine. Mortality reviews have traditionally used trigger tools to try and identify preventable deaths, but the majority of hospital deaths are not preventable and lapses in care are often very complex. Over a period of 14 months we performed four PDSA cycles to change the focus of mortality meetings within care of the elderly and stroke medicine at Cumberland Infirmary to look beyond preventable deaths. The aim was to maximise learning from mortality meetings to improve patient care. We used collaborative working at a trust and departmental level, moving from trigger tool preparation to a narrative approach, and we set up strategies to focus and disseminate our learning. The mean number of cases discussed per meeting and the mean number of lessons identified per case discussed increased, as did the learning levels (trust, department, individual). Maintaining multidisciplinary input and consolidating lessons learnt was difficult because of clinical commitments and natural staff turnover. PMID:26734372

  18. Geriatric medicine leadership of health care transformation: to be or not to be?

    PubMed

    Heckman, George A; Molnar, Frank J; Lee, Linda

    2013-01-01

    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

  19. Monitoring Students' Clinical Experiences during a Third-Year Family Medicine Clerkship.

    ERIC Educational Resources Information Center

    Kowlowitz, Vicki; And Others

    1996-01-01

    In a documentation system designed to monitor medical student progress in clerkships at the University of North Carolina, Chapel Hill, students completed an optical scan card for each patient seen, eliciting information on the patient and the experience. Results highlight students' lack of certain experiences and allow comparison of student…

  20. Problem based learning (PBL) vs. Case based curriculum in clinical clerkship, Internal Medicine innovated Curriculum, Student prospective

    PubMed Central

    Aljarallah, Badr; Hassan, Mohammad Saleh

    2015-01-01

    Background The vast majority of PBL experience is in basic science courses. Application of classic Problem based learning in clerkship phase is challenging. Although the clinical case is considered a problem, yet solving this problem following the burrow’s law has faced hurdles. The difficulties are facing the learner, the teacher and curricula. We implement innovative curriculum for the clerkship year in internal medicine course. Method We surveyed the student just before coming to an internal medicine course to ask them about continuing PBL or other types of learning in clinical years. A committee was created to study the possible ways to integrate PBL in the course. After multiple brainstorming meeting, an innovated curriculum was implemented. Student surveyed again after they completed their course. The survey is asking them about what is the effect of the implemented curriculum in their skills, attitude, and knowledge. Results 70% of Students, who finished their basic science in PBL, preferred not to have classical PBL, but more a clinical oriented case based curriculum in the clinical years. After this innovated curriculum, 50–60 % of students who completed it showed a positive response in all aspects of effects including skill, attitude, and knowledge. The Innovated curriculum includes daily morning report, 3 bedside teaching, investigation session, and clinical reasoning weekly, and Lectures up to twice a week. Conclusion We suggest implementing a curriculum with PBL and case-based criteria in clinical phase are feasible, we are providing a framework with this innovated curriculum. PMID:26309433

  1. Building a Learning Experience: The Implementation of a Clerkship in Geriatric Medicine.

    ERIC Educational Resources Information Center

    Duque, Gustavo; Bonnycastle, Michael; Nazerali, Najmi; Bailey, Robert; Ferrier, Catherine; Heilpern, Paul; Gold, Susan

    2003-01-01

    In a mandatory 4-week program, medical students assessed and managed the care of frail elderly with acute medical problems and disabilities. Web-based lectures with pre/posttests and electronic portfolio assessment were included. The experience was intended to promote reflection, interactive learning, and feedback. (Contains 24 references.) (SK)

  2. Report of the Geriatrics-Hospice and Palliative Medicine Work Group: American Geriatrics Society and American Academy of Hospice and Palliative Medicine leadership collaboration.

    PubMed

    2012-03-01

    Although the fields of hospice and palliative medicine and geriatrics have developed from separate origins, they share much in common. They share concerns for optimizing care of older adults with advanced illness. They both seek to address the common problem of care fragmentation for those with chronic illness. Both subspecialties see the patient and their loved ones as a unit requiring thoughtful, integrated care, rather than seeing the patient as a cluster of organ systems and conditions. The fields also share many core principles, including an emphasis on interdisciplinary care and care coordination. As increasing emphasis is placed on the medical home, chronic and advanced illness care, and systems changes to decrease care fragmentation, geriatrics and hospice and palliative medicine stand to benefit by blending efforts and common interests to improve care for patients and their loved ones. In 2009, a collaborative effort was begun involving the leadership of the American Geriatrics Society, the American Academy of Hospice and Palliative Medicine, and the John A. Hartford Foundation. The goal of the collaboration was to convene leaders in geriatrics and hospice and palliative medicine to identify areas of potential synergy between the two subspecialties and to design a plan for exploring and developing these areas of common interest. This article describes the progress of the collaborative effort to date. PMID:22329491

  3. Development of an Ambulatory Geriatrics Knowledge Examination for Internal Medicine Residents

    PubMed Central

    Kalender-Rich, Jessica L.; Mahnken, Jonathan D.; Dong, Lei; Paolo, Anthony M.; Hayley, Deon Cox; Rigler, Sally K.

    2013-01-01

    Background The number of older adults needing primary care exceeds the capacity of trained geriatricians to accommodate them. All physicians should have basic knowledge of optimal outpatient care of older adults to enhance the capacity of the system to serve this patient group. To date, there is no knowledge-assessment tool that focuses specifically on geriatric ambulatory care. Objective We developed an examination to assess internal medicine residents' knowledge of ambulatory geriatrics. Methods A consensus panel developed a 30-question examination based on topics in the American Board of Internal Medicine (ABIM) Certification Examination Blueprint, the ABIM in-training examinations, and the American Geriatrics Society Goals and Objectives. Questions were reviewed, edited, and then administered to medical students, internal medicine residents, primary care providers, and geriatricians. Results Ninety-eight individuals (20 fourth-year medical students, 57 internal medicine residents, 11 primary care faculty members, and 10 geriatrics fellowship-trained physicians) took the examination. Based on psychometric analysis of the results, 5 questions were deleted because of poor discriminatory power. The Cronbach α coefficient of the remaining 25 questions was 0.48; however, assessment of interitem consistency may not be an appropriate measure, given the variety of clinical topics on which questions were based. Scores increased with higher levels of training in geriatrics (P < .001). Conclusion Our preliminary study suggests that the examination we developed is a reasonably valid method to assess knowledge of ambulatory geriatric care and may be useful in assessing residents. PMID:24455023

  4. Geriatric medicine, Japanese Alzheimer's disease neuroimaging initiative and biomarker development.

    PubMed

    Arai, Hiroyuki; Okamura, Nobuyuki; Furukawa, Katsutoshi; Kudo, Yukitsuka

    2010-06-01

    Due to a change in disease spectrum in aged countries, the primary role of geriatricians should be directed to an appropriate management and prevention of 1) cognitive decline and dementia, 2) swallowing and aspiration pneumonia and 3) falls and fractures. Management of dementia constitutes a central part in the practice of geriatric medicine in order to support independence of life in elderly people. The current paradigm of cognitive function-based testing for the diagnosis and treatment of Alzheimer's disease (AD) is going to drastically shift to a biomarker-based test approach, a shift that will correspond to the emergence of disease-modifying drugs. In addition, a new molecular imaging technique that visualizes neuronal protein deposits or pathological features has been developed in Japan and the U.S.A. Based on these achievements, the Alzheimer's Disease Neuroimaging Initiative (ADNI) was proposed and initiated in 2005. The ADNI is a long-term observational study being conducted in the U.S.A., Europe, Australia, and Japan using identical protocols. The objectives of ADNI are: 1) to establish methodology which will allow standard values related to long-term changes in imaging data, such as MRI and PET, in patients with AD and mild cognitive impairment and normal elderly persons; 2) to obtain clinical indices, psychological test data, and blood/cerebrospinal fluid biomarkers to demonstrate the validity of image-based surrogate markers; and 3) to establish optimum methods to monitor the therapeutic effects of disease-modifying drugs for AD. Patient enrollment in the Japanese ADNI has begun in July 2008. Imaging of AD pathology not only acts as a reliable biomarker with which to assay curative drug development by novel pharmaceutical companies, but it also helps health promotion toward AD prevention. PMID:20467230

  5. Construct Validity of Three Clerkship Performance Assessments

    ERIC Educational Resources Information Center

    Lee, Ming; Wimmers, Paul F.

    2010-01-01

    This study examined construct validity of three commonly used clerkship performance assessments: preceptors' evaluations, OSCE-type clinical performance measures, and the NBME [National Board of Medical Examiners] medicine subject examination. Six hundred and eighty-six students taking the inpatient medicine clerkship from 2003 to 2007

  6. Salvaging a geriatric medicine academic program in disaster mode-the LSU training program post-Katrina.

    PubMed Central

    Cefalu, Charles A.; Schwartz, Robert S.

    2007-01-01

    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

  7. Fellows' Perceptions of a Mandatory Reflective Electronic Portfolio in a Geriatric Medicine Fellowship Program

    ERIC Educational Resources Information Center

    Ruiz, Jorge G.; Qadri, Syeda S.; Karides, Marina; Castillo, Carmen; Milanez, Marcos; Roos, Bernard A.

    2009-01-01

    Electronic portfolios (ePortfolios) can be useful for evaluating and documenting mastery of competencies. We investigated geriatric medicine fellows' perceptions of an ePortfolio. We conducted surveys and focus groups followed by quantitative and qualitative data analysis. Our study revealed that fellows considered the ePortfolio acceptable and…

  8. Educational games in geriatric medicine education: a systematic review

    PubMed Central

    2010-01-01

    Objective To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. Methods We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) and excluded single arm studies. Population of interests included members (practitioners or students) of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. Results We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. Conclusion The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly. PMID:20416055

  9. Geriatric Core Competencies for Family Medicine Curriculum and Enhanced Skills: Care of Elderly

    PubMed Central

    Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne

    2014-01-01

    Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Results Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Conclusions Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit. PMID:24883163

  10. Assessing Effectiveness of a Geriatrics Rotation for Second-Year Internal Medicine Residents

    PubMed Central

    Siegler, Eugenia L.; Jalali, Cathy; Finkelstein, Emily; Ramsaroop, Sharda; Ouchida, Karin; Carmen, Tessa Del; Logio, Lia

    2014-01-01

    Background Residents need to acquire an understanding of the biopsychosocial aspects of caring for older adults with chronic illness, along with effective use of interdisciplinary services inside and outside of the hospital. Objective We expanded the geriatric medicine experience for second-year internal medicine residents and present the results of the first year's experience. Methods We paired a mandatory rotation for postgraduate year–2 internal medicine residents (2 weeks of day and 1 week of night inpatient experience in the Acute Care for Elders Unit), and a 1-week outpatient systems-based practice experience with online modules and readings. Evaluation included a case presentation, an oral examination, a written questionnaire for all residents, and a global assessment of the residents' performance on the geriatrics portion of the 2012 In-Training Examination (ITE). Results All residents passed their oral examination; there was little difference between classes in systems-based practice knowledge. More than 90% (21 of 23) of the residents who took the rotation reported that it left a lasting impression on how they would care for their patients. Mean ITE scores in geriatrics for all residents increased from 53% (versus 61% overall) in 2010 to 87% (versus 81%) in 2012, although they dropped to 69% (versus 82%) in 2013. Conclusions A rotation in geriatrics that is highly rated and covers both acute care and systems-based practice concepts is feasible for internal medicine residents. Residents did not learn detailed knowledge about specific programs for older adults, but clinical geriatrics knowledge improved. PMID:26279779

  11. Frail bodies: geriatric medicine and the constitution of the fourth age.

    PubMed

    Pickard, Susan

    2014-05-01

    Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally. PMID:25650444

  12. Geriatric rehabilitation.

    PubMed

    Flax, H J

    1990-01-01

    Aging is not a disease, nor are there any diseases exclusive to old age. There are physiological changes that occur with aging that lead to functional impairment and eventually death. The geriatric patient usually has several medical problems under treatment concurrently. Therapeutic and technical procedures used in the rehabilitation of geriatric patients are essentially the same as those used in the general practice of rehabilitation medicine. Successful rehabilitation of geriatric patients requires a cooperative and dynamic involvement of all the team professionals, patient and family. Treatment of an elderly stroke patient is outlined as an example of geriatric rehabilitation. PMID:2180418

  13. Perceived Needs for Geriatric Education by Medical Students, Internal Medicine Residents and Faculty

    PubMed Central

    Drickamer, Margaret A; Levy, Becca; Irwin, Kevin S; Rohrbaugh, Robert M

    2006-01-01

    CONTEXT Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents. OBJECTIVE To seek input from medical students and internal medicine residents (“trainees”) on their perception of their needs for training in Geriatrics. DESIGN Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds. RESULTS Trainees perceived training gaps in caring for elderly patients in the areas of (1) recognizing and addressing the complex, multifactorial nature of illness; (2) setting priorities and goals for work-up and intervention; (3) communication with families and with patients with cognitive disorders; (4) assessment of a patient for discharge from the hospital and the services at different sites in which patients may receive care. They recounted feeling overwhelmed by complex patients and social situations while acknowledging the special aspects of connecting with older patients. The gaps identified by trainees differ from and complement the curriculum guidelines set by expert recommendations. CONCLUSION Trainees identified gaps in skills and knowledge leading to trainee frustration and potentially adverse outcomes in caring for elderly patients. Development of curriculum guidelines should include assessment of trainees' perceived learning needs. PMID:17105521

  14. [Geriatric multimorbidity--one of the key problem of contemporary medicine].

    PubMed

    Weber, Pavel; Prudius, Dana; Meluzínová, Hana

    2015-12-01

    In the elderly population there are common permanent decrease of functional capacity, gradual emergence of various diseases leading to the wider multimorbidity and increased problems in the social sphere, which can develop frailty and social dependency. The paper analyzes the complex issue of geriatric multimorbidity and emphasizes its pitfalls, the need of an interdisciplinary approach and thinking of doctors, including the risks of modern pharmacotherapy. The aim of geriatric medicine is to optimize residual functions despite the decline in total functional capacity with increasing multimorbidity. The authors want to direct the attention of the professional community to the permanently growing numbers of the elderly and to emphasize the need of awareness of the problem so that they could understand and cope with this absolutely new reality. PMID:26806500

  15. Interprofessional simulation training improves knowledge and teamwork in nursing and medical students during internal medicine clerkship.

    PubMed

    Tofil, Nancy M; Morris, Jason L; Peterson, Dawn Taylor; Watts, Penni; Epps, Chad; Harrington, Kathy F; Leon, Kevin; Pierce, Caleb; White, Marjorie Lee

    2014-03-01

    Simulation is effective at improving healthcare students' knowledge and communication. Despite increasingly interprofessional approaches to medicine, most studies demonstrate these effects in isolation. We enhanced an existing internal medicine curriculum with immersive interprofessional simulations. For ten months, third-year medical students and senior nursing students were recruited for four, 1-hour simulations. Scenarios included myocardial infarction, pancreatitis/hyperkalemia, upper gastrointestinal bleed, and chronic obstructive pulmonary disease exacerbation. After each scenario, experts in medicine, nursing, simulation, and adult learning facilitated a debriefing. Study measures included pre- and post-tests assessing self-efficacy, communication skills, and understanding of each profession's role. Seventy-two medical students and 30 nursing students participated. Self-efficacy communication scores improved for both (medicine, 18.9 ± 3.3 pretest vs 23.7 ± 3.7 post-test; nursing, 19.6 ± 2.7 pretest vs 24.5 ± 2.5 post-test). Both groups showed improvement in "confidence to correct another healthcare provider in a collaborative manner" (Δ = .97 medicine, Δ = 1.2 nursing). Medical students showed the most improvement in "confidence to close the loop in patient care" (Δ = .93). Nursing students showed the most improvement in "confidence to figure out roles" (Δ = 1.1). This study supports the hypothesis that interdisciplinary simulation improves each discipline's self-efficacy communication skills and understanding of each profession's role. Despite many barriers to interprofessional simulation, this model is being sustained. PMID:24420579

  16. Effective Teaching Methods for Geriatric Competencies

    ERIC Educational Resources Information Center

    Strano-Paul, Lisa

    2011-01-01

    This study assesses how effective classroom sessions are at teaching geriatric competencies to medical students. At Stony Brook Medical School, most geriatric competencies are taught in the Ambulatory Care Clerkship during small-group educational sessions. Clinical exposure to reinforce these specialized skills varies with preceptor assignment. A…

  17. The quality of surgical clerkships.

    PubMed

    Holden, W D

    1985-06-01

    Many of the contours of a surgical clerkship can be designed, implemented, and evaluated with varying degrees of objectivity. The recently established Association for Surgical Education and its expanding membership have performed in an excellent fashion in addressing the objectives, content, process, and evaluation of surgical clerkships. There are several factors that influence the quality of a clerkship that are not readily subjected to measurement but that have a significant impact on the environment and conduct of clerkships. Criticism, mainly from the academic community, has been directed recently to distortions of the learning process and the continuing use of traditional teaching methods that do not serve medical educational programs and students optimally. More attention should be paid to the principle that a surgical clerkship should be designed to provide an elemental comprehension of the major surgical diseases irrespective of how the students will select multiple specialties for their careers. The quality of a clinical teaching program is influenced in a realistic way by the quality of care provided to the patients. The image of the staff, especially the resident staff, plays an important role in affecting students' incentives, the development of self-discipline, their attitudes toward patients and families, and the ultimate selection of careers. As much responsibility as possible for the diagnosis of disease and the care of patients should be given to students under close supervision and always with the best interests of the patients in mind. The environment of medical schools and teaching hospitals is changing rapidly. The corporate practice of medicine will have an impact on the quality of surgical clerkships, we hope not adversely. PMID:4002120

  18. Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

    PubMed Central

    Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.

    2011-01-01

    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

  19. Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient’s Hospital Length of Stay?

    PubMed Central

    Greenberg, Sarah E.; VanHouten, Jacob P.; Lakomkin, Nikita; Ehrenfeld, Jesse; Jahangir, Amir Alex; Boyce, Robert H.; Obremksey, William T.; Sethi, Manish K.

    2016-01-01

    Objectives The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Design Retrospective. Setting Urban level 1 trauma center. Patients/Participants Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Interventions Orthopaedic surgery for geriatric hip fracture. Main Outcome Measurements Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Results Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. Conclusions This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient’s expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient’s expected LOS. PMID:26371621

  20. Role of complementary and alternative medicine in geriatric care: A mini review

    PubMed Central

    Siddiqui, Mohammad Jamshed; Min, Chan Sze; Verma, Rohit Kumar; Jamshed, Shazia Qasim

    2014-01-01

    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

  1. Mindfulness: reconnecting the body and mind in geriatric medicine and gerontology.

    PubMed

    Rejeski, W Jack

    2008-04-01

    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

  2. Hand Hygiene: Knowledge and Attitudes of Fourth-Year Clerkship Medical Students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia

    PubMed Central

    Hamadah, Reem; Kharraz, Razan; Alshanqity, Airabab; AlFawaz, Danah; Eshaq, Abdulaziz M

    2015-01-01

    Introduction: Little is known about the clerkship (clinical) medical students’ knowledge of hand hygiene as the single most important precautionary measure to reduce nosocomial healthcare-associated infections. The aim of this study is to explore the knowledge of, and attitudes towards, hand hygiene practices among fourth-year clerkship medical students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional, paper-based, Yes/No formatted questionnaire was administered to explore the students’ knowledge of, and attitudes towards, hand hygiene practices. Data were decoded in Microsoft Excel sheet and presented as numbers and percentages. Results: One hundred and eleven students (n=111/147) participated in the questionnaire (response rate: 76%). Although the majority of students had a fair knowledge of hand hygiene practices, a number of them had some misconceptions. Only 14% of students correctly agreed to the statement: "Traditional hand washing (water, plus regular soap) decreases the number of germs." Furthermore, only 32% of students correctly answered that "hand washing with a regular soap, instead of an antiseptic soap, is better in limiting the transmission of clostridium difficile infections". Almost all students (93%) agreed to the importance of hand hygiene education in medical curricula and its awareness in healthcare centers. Despite the importance of hand hygiene, only 13% of students reviewed the respective WHO and CDC guidelines before starting their clinical training in the teaching hospital. Discussion: The students’ inadequate knowledge about hand hygiene needs to be enriched by well-structured curricular and extra-curricular programs as well as more positive attitudes by healthcare workers. PMID:26430584

  3. [Geriatrics from the 19th to the 21st century. 150 years of geriatric medicine: from increasing life expectancy to improving quality of life for the very old].

    PubMed

    Federspiel C; Keipes M

    2014-01-01

    With the world further aging, geriatric medicine clearly became a necessity: in the 21th century many more people reach older ages by means of continued medical success in expanding lifespan. 150 years ago life expectancy was between 30 to 40 years, but today close to 800 million people are 60 yeas old or more. During the last century aging has been associated with decline and decay, but gradually more people lived ably and healthily in older ages. The expansion in life expectancy has become a synchronism of quality of life: the average 65 year old today is much healthier, physically and mentally fitter, than the average 50 year old 150 years ago, when Alois Alzheimer war born, a period when most nowadays existing geriatric institutions were envisioned and progressively realized over time. Today we strongly believe that a healthy life and, equally, the quality of life of the very old people can be extended with presently existing medical knowledge, based on research, environmental and behavioural changes, by postponing the onset and progression of fatal and disabling diseases and disorders. But very soon ethical considerations concerning all kinds of medical and technological solutions available to maintain or even improve the mental and physical functioning of dependant elderly people will engage our society when deciding how and at what moment in time to make the best decisions and allocate resources. Geriatric medicine will be further challenged by competing and demanding medical and economic needs, when marshalling resources to meet the growing demands of our society for improving care for the very old and often demented adult. PMID:25438479

  4. [Medicine for the elderly or science of old age? Max Bürger's contribution to geriatric medicine and gerontology].

    PubMed

    Blumenthal, Sandra; Bruns, Florian

    2015-01-01

    The fact that, due to demographic changes, gerontology and geriatrics are gaining ever more importance gives rise to more questions regarding the history of the science of aging. Based on unpublished sources and relevant publications by Max Bürger, the doyen of gerontological research in Germany, our contributions trace the beginnings of age research in Germany. Our results confirm Bürger as the dominant expert in this field in the first decades of its emergence. Bürger was primarily interested in basic medical-scientific research, and less in clinical geriatrics. His scientific goal was not to establish a medicine for the elderly but a theory of life changes ("biomorphosis"). From the start, he saw aging as a physiological process--a view that is still valid today. His concept of "biomorphosis", however, did not catch on and reveals a constriction in Bürger's thinking, which was to some extent influenced by Hans Driesch's vitalism. Interdisciplinary approaches are noticeable in the natural sciences rather than the humanities or social sciences. Bürger's research was also influenced by the political system he lived in. During National Socialism, which Bürger joined--at least formally--in 1937, his research into labour economics and aging met with considerable interest in connection with the general mobilisation of resources. East Germany also had an interest in questions of labour productivity in old age and the extension of the working life, which meant that Bürger remained a sought-after physician and scientist up into the 1960s. As he grew older himself, Bürger's initially deficit-oriented view of old age gave way to a more positive presentation that attached greater weight to the resources of old age. PMID:26137644

  5. Transitioning between Clerkship Directors

    ERIC Educational Resources Information Center

    Soltys, Stephen M.; Pary, Robert J.; Robinson, Stephen W.; Markwell, Stephen J.

    2011-01-01

    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…

  6. Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine

    PubMed Central

    Fuchs, Stephan; Klement, Andreas; Lichte, Thomas; Abendroth, Jens

    2014-01-01

    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

  7. A National Survey on the Current Status of Family Practice Residency Education in Geriatric Medicine.

    ERIC Educational Resources Information Center

    Li, Ina; Arenson, Christine; Warshaw, Gregg; Bragg, Elizabeth; Shaull, Ruth; Counsell, Steven R.

    2003-01-01

    A survey of family practice residency directors found that 92 percent have a required geriatrics curriculum; nursing homes, assisted living facilities, and home care are the predominant training sites; the mean number of geriatrics faculty is 2.6 per program; and conflicting time demands with other curricula was ranked as the most significant…

  8. [Respiratory medicine in geriatrics. A cultural niche of relevant theoretical and practical importance].

    PubMed

    Leonardi, R; Cossi, S; Tomasi, M F; Guerrini, G; Bellia, V; Grassi, V

    1995-12-01

    Respiratory medicine in the elderly represents a topic of increasing interest in the developed countries, because of its peculiar clinical and therapeutical implications. In this respect, a deeper knowledge of the biology and physiology of aging lung is desirable: namely, the age-related immunological and structural changes involving the respiratory system do influence clinical presentation and response to the treatment in older people. A better understanding of the pharmacology in the elderly which is recognized to be different for several aspects from that of the general population, is mandatory in order to better approach these practical problems. This short review emphasizes the need of the "longitudinal", rather than "transversal", epidemiological surveys which are uniquely able to give useful information on the natural history, even in older populations. In addition, clinical and therapeutical peculiarities of some respiratory illnesses such as infectious lung diseases, including pulmonary tuberculosis, COLD and bronchial asthma, sleep-related respiratory disorders will be underlined. Finally, a few problems concerning the management of the geriatric subject with chronic respiratory disease will be analyzed, focusing mainly on the difficulties inherent in the inhalant therapy and functional evaluation of this kind of patients. PMID:8588088

  9. Death is not always a failure: outcomes from implementing an online virtual patient clinical case in palliative care for family medicine clerkship

    PubMed Central

    Tan, Amy; Ross, Shelley Paige; Duerksen, Kimberley

    2013-01-01

    Background The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care. Aims To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010–2011 Year Three Family Medicine Clerkship rotation curriculum. Methods A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students’ educational experience of using this case. Results Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students’ self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as ‘Good to Excellent’, 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate. Conclusions The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs. PMID:24267774

  10. Geriatric syndromes and geriatric assessment for the generalist.

    PubMed

    Carlson, Charlotte; Merel, Susan E; Yukawa, Michi

    2015-03-01

    Geriatric assessment is an increasingly important area of outpatient medicine, given the unprecedented aging of the US population. Screening and evaluation for geriatric syndromes, particularly falls, urinary incontinence, frailty, and cognitive impairment, are crucial aspects of outpatient geriatric assessment. Innovative models of care are emerging to improve quality of care and enhance cost savings for the geriatric patient. High-value features of geriatric care systems include providing increased 24/7 access to care, a multidisciplinary team-based approach to care, performing medication reconciliation and comprehensive geriatric assessments, and integrating palliative care into treatment planning. PMID:25700583

  11. [150 years of geriatric medicine: from improving life expectation to better quality of life for the very old ].

    PubMed

    Federspiel C; Keipes M

    2014-01-01

    With the world further aging, geriatric medicine clearly became a necessity: in the 21th century many more people reach older ages by means of continued medical success in expanding lifespan. 150 years ago life expectancy was between 30 to 40 years, but today close to 800 million people are 60 yeas old or more. During the last century aging has been associated with decline and decay, but gradually more people lived ably and healthily in older ages. The expansion in life expectancy has become a synchronism of quality of life: the average 65 year old today is much healthier, physically and mentally fitter, than the average 50 year old 150 years ago, when Alois Alzheimer war born, a period when most nowadays existing geriatric institutions were envisioned and progressively realized over time. Today we strongly believe that a healthy life and, equally, the quality of life of the very old people can be extended with presently existing medical knowledge, based on research, environmental and behavioural changes, by postponing the onset and progression of fatal and disabling diseases and disorders. But very soon ethical considerations concerning all kinds of medical and technological solutions available to maintain or even improve the mental and physical functioning of dependant elderly people will engage our society when deciding how and at what moment in time to make the best decisions and allocate resources. Geriatric medicine will be further challenged by competing and demanding medical and economic needs, when marshalling resources to meet the growing demands of our society for improving care for the very old and often demented adult. PMID:25507996

  12. Clinical Nuclear Pharmacy Clerkship

    ERIC Educational Resources Information Center

    Dunson, George L.; Christopherson, William J., Jr.

    1977-01-01

    The School of Pharmacy, University of the Pacific, and the Pharmacy Service, Letterman Army Medical Center, initiated a 15-week clinical nuclear pharmacy clerkship in 1975. It includes basic nuclear medical science, technical competency, professional competency, and special interest emphasis. (LBH)

  13. Geriatrics: Profiles in Geriatrics

    MedlinePlus

    ... Professor of Public Policy and Urban Affairs, Northeastern University "I have the same passion today that I ... teaching hospitals. more info Irene Moore, MSSW, LISW University of Cincinnati "Geriatrics is a wide open field. ...

  14. [Geriatrics for internists in primary care].

    PubMed

    Swoboda, W; Hermens, T

    2011-08-01

    Internal medicine specialists involved in primary care will have a leading part in the treatment of geriatric patients with complex healthcare needs in the future. Approved models like specialized geriatric practices, ambulant or mobile geriatric rehabilitation and special geriatric services for nursing homes are available. Essential is a geriatric qualification that fits with the tasks of an internist in primary care. An incentive payment system has to be created for this purpose to improve the treatment of elderly patients. PMID:21750935

  15. 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

    2012-01-01

    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…

  16. Students' Educational Activities During Clerkship.

    ERIC Educational Resources Information Center

    O'Sullivan, Patricia S.; And Others

    1997-01-01

    Logs completed by 201 medical students in third-year clerkships at nine community-based hospitals indicated students received 6.5 hours of teaching with an instructor daily, spending 4.9 more hours in clerkship-related learning. Most teaching was by full-time faculty and residents. In half their educational activities, students participated with…

  17. The Development of a Medical Student Interest Group in Geriatrics.

    ERIC Educational Resources Information Center

    Paris, Barbara E. Cammer

    1998-01-01

    Since 1988, a special interest group in geriatrics has provided students at Mount Sinai School of Medicine a forum for pursuing research interests, networking, and interacting with faculty. Such groups foster interest in careers in geriatric medicine. (SK)

  18. [The geriatric university clinic].

    PubMed

    Stähelin, H B

    1995-01-01

    The very old are the fastest growing population group. Medical progress allows more autonomy and better quality of life for the elderly. Traditional medical concepts are, however, only partly suited for dealing with age-associated problems. Medical education responds to these new requirements in a limited way. Interdisciplinary teamwork is a prerequisite in treating the multimorbid, acutely ill elderly patient. The task of the university is not only the development and implementation of high-tech medicine, but first of all a comprehensive training in medicine, including geriatrics. The Geriatric University Clinic therefore offers pre- and postgraduate training in geriatrics, but also in related disciplines by promoting teaching and research. In order to attain these goals, the geriatric acute ward was created for acutely ill, very old, multimorbid, frail elderly patients. A geriatric ward for rehabilitation complements this ward. A consultation service offers geriatric know-how to all other services. A special task is the early diagnosis and treatment of dementia in an outpatient service. The aim is to prevent chronification by early intervention and to reestablish satisfactory function and autonomy. PMID:7780809

  19. Hospital nutrition in geriatric long-term care medicine: II. Effects of dietary supplements.

    PubMed

    Elmsthl, S; Steen, B

    1987-03-01

    The effects of three different dietary supplements were studied in 28 women admitted to geriatric long-term care by recording the dietary intake, anthropometric variables and selected biochemical analyses before and during an 8-week experimental period. The validity of the dietary intake measurements was investigated and judged as acceptable. Before supplementation the mean daily intake of energy was 5.2 MJ/1247 kcal and vitamin D and thiamine were the nutrients most commonly deficient. One third of the patients had low dietary intake of vitamin A. The intake of ascorbic acid, riboflavine and calcium were appropriate. The mean values of haemoglobin, serum albumin, plasma prealbumin and transferrin were within reference limits despite the fact that a quarter of the patients had signs of inflammation. The dietary intake improved significantly during the experimental period in all three groups and the intake of energy increased by 25%. A gain of weight was noted in all groups. The level of serum retinol-binding protein increased in two of the groups. The suppression of the appetite due to supplementation was low and the intake of snacks decreased from 20% to 11% of the energy intake. PMID:3107353

  20. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

    PubMed

    Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu

    2015-12-01

    The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients. PMID:25986479

  1. [Emergency medicine after a catastrophic disaster: from a view of geriatrics and gerontology].

    PubMed

    Okinaga, Shoji; Daito, Hisayoshi; Suzuki, Motoi; Shiihara, Jun; Arai, Hiroyuki

    2013-06-01

    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

  2. Effects and feasibility of an Integrative Medicine program for geriatric patients–a cluster-randomized pilot study

    PubMed Central

    Teut, Michael; Schnabel, Katharina; Baur, Roland; Kerckhoff, Annette; Reese, Frauke; Pilgram, Niels; Berger, Franziska; Luedtke, Rainer; Witt, Claudia M

    2013-01-01

    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

  3. Longitudinal continuity experiences can repair disconnects in the core clerkships for medical students.

    PubMed

    Stevens, Carl D; Wilkerson, LuAnn; Uijtdehaage, Sebastian

    2014-02-01

    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

  4. American Geriatrics Society/Association of Directors of Geriatric Academic Programs curricular milestones for graduating geriatric fellows.

    PubMed

    Parks, Susan M; Harper, G Michael; Fernandez, Helen; Sauvigne, Karen; Leipzig, Rosanne M

    2014-05-01

    This article describes the curricular milestones for geriatric fellows and the process used to develop them. The curricular milestones were developed to determine what every graduating geriatric fellow should be able to demonstrate to ensure that they will be able to practice effectively and safely in all care settings and with different older adult populations. Three major domains were identified: Caring for the Elderly Patient, Systems-Based Care for Elder Patients, and Geriatric Syndromes. Six hundred thirty-five geriatricians each reviewed and commented on one domain. These geriatricians represented important stakeholder groups: geriatric fellowship program directors; Association of Directors of Geriatric Academic Programs (ADGAP) members, who are primarily geriatric program and fellowship directors; the American Geriatrics Society (AGS) and ADGAP Education Committee; the AGS Teacher's Section; Geriatric Academic Career Award awardees; and through the American Board of Internal Medicine and the American Board of Family Medicine, board-certified geriatricians who spend more than 50% of their time in clinical practice. The AGS and ADGAP boards approved the final set of 76 Geriatric Curricular Milestones, which were posted on the Portal of Geriatric Online Education in December 2012. These curricular milestones are intended to assist geriatric fellowship directors as they develop curricula and assessments to inform program director reporting to the Accreditation Council for Graduate Medical Education in the Next Accreditation System, which begins in July 2014. PMID:24749808

  5. 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

    2011-01-01

    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

  6. 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

    2011-01-01

    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…

  7. A Curricular Model for Geriatric-Gerontology Education in Pharmacy Practice.

    ERIC Educational Resources Information Center

    Higbee, Martin D.

    1984-01-01

    A three-component geriatric-gerontology program developed at the University of Utah is described that consists of a lecture course, clinical clerkships, and a gerontology certificate program. This multidisciplinary approach enables students to gain a broad perspective in the complex health care of the elderly. (Author/MLW)

  8. 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.

    2004-01-01

    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…

  9. The "Shrinking" Clerkship: Characteristics and Length of Clerkships in Psychiatry Undergraduate Education

    ERIC Educational Resources Information Center

    Rosenthal, Renate H.; Levine, Ruth E.; Carlson, David L.; Clegg, Kathleen A.; Crosby, Ross D.

    2005-01-01

    OBJECTIVE: The authors explored the time that is currently devoted to psychiatry clerkships to determine whether "shortened" clerkships differ in course director satisfaction and evaluation strategies. METHOD: An 18-item questionnaire was sent to 150 U.S. and Canadian clerkship directors. RESULTS: The return rate was 74% (111 questionnaires).…

  10. Nutraceuticals for geriatrics.

    PubMed

    Gupta, Charu; Prakash, Dhan

    2015-01-01

    Geriatrics is a medical practice that addresses the complex needs of older patients and emphasizes maintaining functional independence even in the presence of chronic disease. Treatment of geriatric patients requires a different strategy and is very complex. Geriatric medicines aim to promote health by preventing and treating diseases and disabilities in older adults. Development of effective dietary interventions for promoting healthy aging is an active but challenging area of research because aging is associated with an increased risk of chronic disease, disability, and death. Aging populations are a global phenomenon. The most widespread conditions affecting older people are hypertension, congestive heart failure, dementia, osteoporosis, breathing problems, cataract, and diabetes to name a few. Decreased immunity is also partially responsible for the increased morbidity and mortality resulting from infectious agents in the elderly. Nutritional status is one of the chief variables that explains differences in both the incidence and pathology of infection. Elderly people are at increased risk for micronutrient deficiencies due to a variety of factors including social, physical, economic, and emotional obstacles to eating. Thus there is an urgent need to shift priorities to increase our attention on ways to prevent chronic illnesses associated with aging. Individually, people must put increased efforts into establishing healthy lifestyle practices, including consuming a more healthful diet. The present review thus focuses on the phytochemicals of nutraceutical importance for the geriatric population. PMID:26151003

  11. Nutraceuticals for geriatrics

    PubMed Central

    Gupta, Charu; Prakash, Dhan

    2014-01-01

    Geriatrics is a medical practice that addresses the complex needs of older patients and emphasizes maintaining functional independence even in the presence of chronic disease. Treatment of geriatric patients requires a different strategy and is very complex. Geriatric medicines aim to promote health by preventing and treating diseases and disabilities in older adults. Development of effective dietary interventions for promoting healthy aging is an active but challenging area of research because aging is associated with an increased risk of chronic disease, disability, and death. Aging populations are a global phenomenon. The most widespread conditions affecting older people are hypertension, congestive heart failure, dementia, osteoporosis, breathing problems, cataract, and diabetes to name a few. Decreased immunity is also partially responsible for the increased morbidity and mortality resulting from infectious agents in the elderly. Nutritional status is one of the chief variables that explains differences in both the incidence and pathology of infection. Elderly people are at increased risk for micronutrient deficiencies due to a variety of factors including social, physical, economic, and emotional obstacles to eating. Thus there is an urgent need to shift priorities to increase our attention on ways to prevent chronic illnesses associated with aging. Individually, people must put increased efforts into establishing healthy lifestyle practices, including consuming a more healthful diet. The present review thus focuses on the phytochemicals of nutraceutical importance for the geriatric population. PMID:26151003

  12. [Tele-cooperation for innovative care using the example of the University Hospital Aachen. Telematics in intensive care medicine, emergency medicine, and telemedical intersectoral rehabilitation planning in geriatric trauma].

    PubMed

    Marx, Gernot; Beckers, Rainer; Brokmann, Jörg Christian; Deisz, Robert; Pape, Hans-Christoph

    2015-10-01

    The demographic challenge of the ageing society is associated with increasing comorbidity. On the other hand, there will be an ageing workforce in medicine, resulting in an imbalance between the demand and supply of medical care in the near future. In rural areas in particular, this imbalance is already present today. Based on three best practice projects carried out by our telemedical center in Aachen, including emergency medicine, intensive care medicine, and the rehabilitation planning of geriatric trauma care, some experience and the potential of the intersectoral provision of care, supported by telemedicine, are demonstrated. Telemedicine is the provision of medical services over a geographical distance by using tele-communication and data transfer. It has been proven to ensure a constant quality of health care. Telemedical support enables shared expertise independent of time and space, and allows efficient allocation of resources. A review of international experience supports this notion. PMID:26281718

  13. Efficacy and safety of the Chinese herbal medicine shuganjieyu with and without adjunctive repetitive transcranial magnetic stimulation (rTMS) for geriatric depression: a randomized controlled trial

    PubMed Central

    XIE, Minmin; JIANG, Wenhai; YANG, Haibo

    2015-01-01

    Background Pharmacological treatment of geriatric depression is often ineffective because patients cannot tolerate adequate doses of antidepressant medications. Aim Examine the efficacy and safety of shuganjieyu – the first Chinese herbal medicine approved for the treatment of depression by China’s drug regulatory agency -- with and without adjunctive treatment with repetitive transcranial magnetic stimulation (rTMS) in the treatment of geriatric depression. Methods Sixty-five inpatients 60 or older who met ICD-10 criteria for depression were randomly assigned to an experimental group (shuganjieyu + rTMS) (n=36) or a control group (shuganjieyu + sham rTMS)(n=29). All participants received 4 capsules of shuganjieyu daily for 6 weeks. rTMS (or sham rTMS) was administered 20 minutes daily, five days a week for 4 weeks. Blinded raters used the Hamilton Rating Scale for Depression (HAMD-17) and the Treatment Emergent Symptom Scale to assess clinical efficacy and safety at baseline and 1, 2, 4, and 6 weeks after starting treatment. Over the six-week trial, there was only one dropout from the experimental group and two dropouts from the control group. Results None of the patients had serious side effects, but 40% in the experimental group and 50% in the control group experienced minor side effects that all resolved spontaneously. Both groups showed substantial stepwise improvement in depressive symptoms over the 6 weeks. Repeated measures ANOVA found no differences between the two groups. After 6 weeks, 97% of the experimental group had experienced a 25% or greater drop in the level of depression, but only 20% had experience a 50% or greater drop in the level of depression; the corresponding values in the control group were 96% and 19%. There were some minor, non-significant differences in the onset of the treatment effect between the different types of depressive symptoms, but by the second week of treatment all five HAMD-17 subscale scores had improved significantly in both groups Conclusion The Chinese herbal medicine shuganjieyu is effective and safe in the treatment of geriatric depression, but only a minority of patients have greater than 50% improvement in their depressive symptoms after 6 weeks of treatment. Adjunctive use of rTMS with shuganjieyu does not improve the overall outcome and does not significantly speed up the onset of action of shuganjieyu. PMID:26120260

  14. Geriatric Technician.

    ERIC Educational Resources Information Center

    Seton Hill Coll., Greensburg, PA.

    This curriculum for training geriatric technicians is geared toward developing an understanding of, as well as the skills to assist with, the visually or hearing impaired older adult. The curriculum is organized in four modules. Each module is assigned a time frame and a credit unit base. The modules are divided into four major areas: knowledge,…

  15. An Evaluation of a Clerkship In Cardiology

    ERIC Educational Resources Information Center

    Edson, John N.; and others

    1969-01-01

    Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

  16. Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center and a Community Health System

    PubMed Central

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

    2014-01-01

    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

  17. Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

    PubMed

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

    2014-01-01

    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

  18. Guidelines for Graduate Medical Education in Geriatrics.

    ERIC Educational Resources Information Center

    Robbins, Alan S.; Beck, John C.

    1982-01-01

    Performance objectives, core content, training experiences, and clinical exposure and program evaluations are described for geriatric fellows and house staff members in internal medicine, family practice, neurology, and psychiatry. A modified Delphi study was used. (Author/MLW)

  19. Construct validity and generalizability of pediatrics clerkship evaluation at a problem-based medical school, Bahrain.

    PubMed

    Al-Mahroos, Fadheela

    2009-06-01

    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

  20. Clerkship rotation in rural family practice

    PubMed Central

    Lewis, John

    1995-01-01

    Every medical student at Memorial University of Newfoundland must do a rotation in rural family practice. This paper describes the organization of this clerkship learning experience and discusses its possible influence upon career choice. ImagesFigure 1 PMID:7780316

  1. Grade Inflation in Medical Student Radiation Oncology Clerkships: Missed Opportunities for Feedback?

    SciTech Connect

    Grover, Surbhi; Swisher-McClure, Samuel; Sosnowicz, Stasha; Li, Jiaqi; Mitra, Nandita; Berman, Abigail T.; Baffic, Cordelia; Vapiwala, Neha; Freedman, Gary M.

    2015-07-15

    Purpose: To test the hypothesis that medical student radiation oncology elective rotation grades are inflated and cannot be used to distinguish residency applicants. Methods and Materials: The records of 196 applicants to a single radiation oncology residency program in 2011 and 2012 were retrospectively reviewed. The grades for each rotation in radiation oncology were collected and converted to a standardized 4-point grading scale (honors, high pass, pass, fail). Pass/fail grades were scored as not applicable. The primary study endpoint was to compare the distribution of applicants' grades in radiation oncology with their grades in medicine, surgery, pediatrics, and obstetrics/gynecology core clerkships. Results: The mean United States Medical Licensing Examination Step 1 score of the applicants was 237 (range, 188-269), 43% had additional Masters or PhD degrees, and 74% had at least 1 publication. Twenty-nine applicants were graded for radiation oncology rotations on a pass/fail basis and were excluded from the final analysis. Of the remaining applicants (n=167), 80% received the highest possible grade for their radiation oncology rotations. Grades in radiation oncology were significantly higher than each of the other 4 clerkships studied (P<.001). Of all applicants, 195 of 196 matched into a radiation oncology residency. Higher grades in radiation oncology were associated with significantly higher grades in the pediatrics core clerkship (P=.002). However, other medical school performance metrics were not significantly associated with higher grades in radiation oncology. Conclusions: Although our study group consists of a selected group of radiation oncology applicants, their grades in radiation oncology clerkships were highly skewed toward the highest grades when compared with grades in other core clerkships. Student grading in radiation oncology clerkships should be re-evaluated to incorporate more objective and detailed performance metrics to allow for meaningful feedback to trainees and to better evaluate residency applicants to radiation oncology.

  2. Geriatrics in family practice residency education: an unmet challenge.

    PubMed

    Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

    2003-01-01

    The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill. PMID:12564861

  3. Progress in Geriatrics: A Clinical Care Update.

    ERIC Educational Resources Information Center

    Blanchette, Patricia Lanoie; And Others

    1997-01-01

    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…

  4. PDA support for outpatient clinical clerkships: mobile computing for medical education.

    PubMed Central

    Speedie, S.; Pacala, J.; Vercellotti, G.; Harris, I.; Zhou, X.

    2001-01-01

    This project provides educational support for students enrolled in a family practice clerkship by supplying PDA-based clinical references and tools to collect information about the patients they see and the seminars they attend. Each student is supplied with a Handspring Visor Deluxe to use during the clerkship. Supplied software includes a clinical reference (Five Minute Clinical Consult) and Lexidrugs drug reference and a medical calculator. The data collection software consists of a patient log for recording simple demographic and diagnostic information about each patient seen during the clerkship, a seminar evaluation module for recording student feedback about each didactic presentation during the course, and an evaluation form where they students supply their reactions to the use of the Visor. Despite encountering a number of problems, the devices appear to be beneficial tools. The applications provide useful references for students who do not have access to the resources of the University in their family medicine clerkship. They also provide an improved, though not perfect, means to capture data regarding patient encounters and course evaluations. However, the challenge remains to better integrate the PDA with the student s workflow in the clinic. PMID:11825262

  5. How medical alumni now see their junior clerkships in surgery.

    PubMed

    Chapman, Jason R; Weidner, Bryan C; Nakayama, Don K

    2011-09-01

    The purpose of this study is to determine the effectiveness and value of the junior medical student surgical clerkship for physicians now in practice. Questionnaires were sent to all Mercer University School of Medicine alumni (1986-2007) using a five-point Likert scale. One hundred and fifty-seven responses were received from 873 recipients (18%), 71 per cent training in nonsurgical specialties. "Scrubbing in" on cases was the most valuable activity (82%), followed by faculty rounds (76%), resident work rounds (70%), and lectures (69%). Least useful activities were question and answer sessions (54%), grand rounds (53%), and morbidity and mortality conferences (57%). The amount of time in the operating room was appropriate for 61 per cent, but to 8 per cent the operating room was a waste of time. Faculty evaluations gave the most effective feedback (75%). Alumni in surgical specialties and obstetrics and gynecology rated their experiences higher than nonsurgical physicians. Overall, only 44 per cent saw the material learned as important to general medical education. Opinions regarding the value of surgical clerkships to current practices were mixed. Undergraduate surgical education should emphasize common surgical conditions, surgical decision-making, and simple procedures relevant to a nonsurgical practice. PMID:21944625

  6. [Definition and outline on geriatric oncology].

    PubMed

    Terret, C; Droz, J-P

    2009-11-01

    Geriatric oncology is the concept for management of elderly cancer patients. It is an equal approach of the health status problems and of cancer in a patient considered as a whole. Therefore it is not a subspecialty but a practice which can be translated in the elderly cancer patient's care. The treatment of cancer is based on the same principles than this of younger patients; recommendations used are those of the scientific oncological societies. Health problems of elderly patients are screened by specific tools. Patients without major health problems are managed by the oncological team in the routine; those for whom screening have demonstrated problems are first evaluated in the geriatrics setting and then oncological decisions are adapted to the patient situation. Decisions are made in specific geriatric oncology conferences. Specific clinical trials are required to build an Evidence Based Medicine background. Geriatric oncology teaching programs are warranted. PMID:20123506

  7. Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

    ERIC Educational Resources Information Center

    McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.

    2009-01-01

    This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…

  8. Patient safety in geriatrics: a call for action.

    PubMed

    Tsilimingras, Dionyssios; Rosen, Amy K; Berlowitz, Dan R

    2003-09-01

    Patient safety has become a major public health concern following the publication of the landmark report, To Err Is Human, by the Institute of Medicine in 1999. This report, along with a subsequent report, Crossing the Quality Chasm, recommended the design of a safer health care system by integrating well-established safety methods to avert medical errors. However, neither patient safety report specifically addressed the implications of safety for elderly patients. This article examines those implications by describing the association between aging and medical errors, identifying geriatric syndromes as medical errors, and focusing on six recommendations that will improve the safety of geriatric care. These six recommendations include the detection and reporting of geriatric syndromes, identifying system failures when geriatric syndromes occur, establishing dedicated geriatric units, improving the continuity of care, reducing adverse drug events, and improving geriatric training programs. PMID:14528037

  9. Accuracy of Surgery Clerkship Performance Raters.

    ERIC Educational Resources Information Center

    Littlefield, John H.; And Others

    1991-01-01

    Interrater reliability in numerical ratings of clerkship performance (n=1,482 students) in five surgery programs was studied. Raters were classified as accurate or moderately or significantly stringent or lenient. Results indicate that increasing the proportion of accurate raters would substantially improve the precision of class rankings. (MSE)

  10. An Innovative Clerkship in Pharmacy Education.

    ERIC Educational Resources Information Center

    Hammer, Dana P.; Paulsen, Susan M.

    2001-01-01

    Describes an elective clerkship rotation in pharmacy education for PharmD students designed to develop their skills and stimulate their interest in the teaching and service aspects of academic life. Student feedback and evaluations of the rotation were very positive. (EV)

  11. Implementation of an Undergraduate Nutritional Support Clerkship.

    ERIC Educational Resources Information Center

    Stennett, Douglass J.; And Others

    1983-01-01

    A 10-week, full-time elective nutritional support clerkship designed for fifth-year pharmacy students is described. The course refines the student's communication skills and develops the student's ability to properly prepare and adjust a nutritional therapy plan. A weekly student activity plan and student evaluation form are appended. (MSE)

  12. Development of a handheld computer documentation system to enhance an integrated primary care clerkship.

    PubMed

    Pipas, Catherine F; Carney, Patricia A; Eliassen, M Scottie; Mengshol, Sarah C; Fall, Leslie H; Olson, Ardis L; Schifferdecker, Karen E; Russell, Margaret T; Peltier, Deborah A; Nierenberg, David W

    2002-07-01

    Documentation systems are used by medical schools and residency programs to record the clinical experiences of their learners. The authors developed a system for their school's (Dartmouth's) multidisciplinary primary care clerkship (family medicine, internal medicine, pediatrics) that documents students' clinical and educational experiences and provides feedback designed to enhance clinical training utilizing a timely data-reporting system. The five critical components of the system are (1) a valid, reliable and feasible data-collection instrument; (2) orientation of and ongoing support for student and faculty users; (3) generation and distribution of timely feedback reports to students, preceptors, and clerkship directors; (4) adequate financial and technical support; and (5) a database design that allows for overall evaluation of educational outcomes. The system, whose development began in 1997, generated and distributed approximately 150 peer-comparison reports of clinical teaching experiences to students, preceptors, and course directors during 2001, in formats that are easy to interpret and use to individualize learning. The authors present report formats and annual cost estimate comparisons of paper- and computer-based system development and maintenance, which range from $35,935 to $53,780 for the paper-based system and from $46,820 to $109,308 for the computer-based system. They mention ongoing challenges in components of the system. They conclude that a comprehensive documentation and feedback system provides an essential infrastructure for the evaluation and enhancement of community-based teaching and learning in primary care ambulatory clerkships, whether separate or integrated. PMID:12114137

  13. [What's new in geriatric medicine].

    PubMed

    Eyer, Stephan; Rochat, Stéphane; Monod, Stéfanie; Büla, Christophe; Gold, Gabriel

    2010-01-13

    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

  14. [Review in geriatric medicine 2011].

    PubMed

    Rochat, S; Doser, N; Eyer, S; Jabri, A; Rubli, E; Büla, C

    2012-01-11

    In 2011, new tools to evaluate life expectancy are available. Controversy about PSA-based screening for prostate cancer is still going on, with new data from the US Preventive services task force. A brief behavioral treatment for insomnia can be efficient and durable. Gliptines are be useful to avoid treatment-induced hypoglycemia in diabetic patients. New Alzheimer diagnostic criteria, including biomarkers, have been published. PMID:22303735

  15. Autonomy and paternalism in geriatric medicine. The Jewish ethical approach to issues of feeding terminally ill patients, and to cardiopulmonary resuscitation.

    PubMed

    Rosin, A J; Sonnenblick, M

    1998-02-01

    Respecting and encouraging autonomy in the elderly is basic to the practice of geriatrics. In this paper, we examine the practice of cardiopulmonary resuscitation (CPR) and "artificial" feeding in a geriatric unit in a general hospital subscribing to jewish orthodox religious principles, in which the sanctity of life is a fundamental ethical guideline. The literature on the administration of food and water in terminal stages of illness, including dementia, still shows division of opinion on the morality of withdrawing nutrition. We uphold the principle that as long as feeding by naso-gastric (N-G) or percutaneous endoscopic gastrostomy (PEG) does not constitute undue danger or arouse serious opposition it should be given, without causing suffering to the patient. This is part of basic care, and the doctor has no mandate to withdraw this. The question of CPR still shows much discrepancy regarding elderly patients' wishes, and doctors' opinions about its worthwhileness, although up to 10 percent survive. Our geriatric patients rarely discuss the subject, but it is openly ventilated with families who ask about it, who are then involved in the decision-making, and the decision about CPR or "do-not-resuscitate" (DNR) is based on clinical and prognostic considerations. PMID:9549682

  16. Development and Qualitative Evaluation of Rural Ambulatory Care Clinical Clerkships.

    ERIC Educational Resources Information Center

    Raisch, Dennis W.; And Others

    1993-01-01

    A University of New Mexico pharmacy clerkship in Indian Health Service rural ambulatory clinics is described and its results compared with an urban hospital clerkship. Unique benefits to participants included improved skills in patient counseling and chart screening, more hands-on experience, extensive individual physician consultations, and…

  17. Use of Standardized Patients during a Psychiatry Clerkship

    ERIC Educational Resources Information Center

    Bennett, Aurora J.; Arnold, Lesley M.; Welge, Jeffrey A.

    2006-01-01

    Objective: Standardized patients are used in teaching medical students and evaluating their clinical skills during the psychiatric clerkship. The purpose of this study was to evaluate whether the addition of a Psychiatry Clinical Standardized Patient Examination (PCX) during the third-year clerkship improved students' performances on the

  18. Lean business model and implementation of a geriatric fracture center.

    PubMed

    Kates, Stephen L

    2014-05-01

    Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. PMID:24721360

  19. Finding the differences between the East and West in clinical clerkship: A Chinese exchange medical student's perspective.

    PubMed

    Yin, Kanhua

    2015-05-01

    As a sixth-year medical student and the first exchange medical student from Fudan University, China, I had the opportunity to take a three-month elective at University of California at Davis (UC Davis) School of Medicine from October 2013 to January 2014. I worked and studied at the Division of Cardiothoracic Surgery, the General Medicine Consults Service, and the Department of Emergency Medicine in those days. This precious experience enhanced my medical knowledge, broadened my view, and at the same time, deepened my understanding of clerkship as part of medical education. PMID:25183495

  20. The Effect of an Ambulatory Internal Medicine Rotation on Students' Career Choices.

    ERIC Educational Resources Information Center

    Bauer, Richard L.; And Others

    1997-01-01

    A study of 184 third-year medical students randomly assigned to ambulatory care and traditional inpatient curricula in an internal medicine clerkship found those with the ambulatory care experience were somewhat more likely to choose an ambulatory care career than those in the traditional curriculum. However, the clerkship experience did not…

  1. [Drawn towards a career in elderly care medicine, but not till after medical school. Elderly care medicine as a career choice].

    PubMed

    Meiboom, A A; de Vries, H; Hesselink, B A M; Hertogh, C M P M; Scheele, F

    2014-01-01

    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

  2. Geriatric Medical Education in Israel

    ERIC Educational Resources Information Center

    Leibovitz, Arthur; Baumoehl, Yehuda; Habot, Beni

    2004-01-01

    In this article we will focus on geriatric medical education in Israel and will review our experience in this field. A coordinated effort of the Ministry of Health and the Israeli Medical Association led to the establishment of a modern geriatric system and to the recognition of geriatrics as a medical specialty in the early 1980s. All four…

  3. [Advances in geriatric cardiology].

    PubMed

    Gómez Sánchez, Miguel A; Bañuelos de Lucas, Camino; Ribera Casado, José M; Pérez Casar, Feliciano

    2006-01-01

    The continued aging of the population is an acknowledged fact. The proportion of individuals in the European Union aged over 65 years will reach 29.9% by 2050, almost double the present figure of 16.4%. Approximately one third of people in this age-group has clinically significant cardiovascular disease. Physicians dealing with cardiology in older patients have to be aware of the specific clinical and prognostic features of cardiovascular disease in the elderly, and with its treatment. Consequently, it is clear that continuing medical education in geriatric cardiology is essential, and that is one of the tasks of the Working Group on Geriatric Cardiology. This special issue provides a magnificent opportunity for presenting an update on important topics in geriatric cardiology, such as the aging of the cardiovascular system, heart failure, and atrial fibrillation. PMID:16540026

  4. At the precipice: a prospective exploration of medical students' expectations of the pre-clerkship to clerkship transition.

    PubMed

    Soo, Jason; Brett-MacLean, Pamela; Cave, Marie-Therese; Oswald, Anna

    2016-03-01

    Medical learners face many challenging transitions. We prospectively explored students' perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition to clerkship. Narratives were separately analyzed by four authors and then discussed to identify a final thematic framework using parsimonious category construction. We identified two overarching themes: (1) "Looking back": experiences which had helped students feel prepared for clerkship with subthemes focused on of patient care, shadowing, classroom teaching and the pre-clerkship years as foundational knowledge, (2) "Looking forward": anticipating the clerkship experience and the journey of becoming a physician with subthemes focused on death and dying, hierarchy, work-life balance, interactions with patients, concerns about competency and career choice. Questionnaire data revealed incongruities around expectations of minimal exposure to death and dying, little need for independent study and limited direct patient responsibility. We confirmed that internal transformations are happening in contemplative time even before clerkship. By prospectively exploring pre-clerkship students' perceptions of the transition to clerkship training we identified expectations and misconceptions that could be addressed with future curricular interventions. While students are aware of and anticipating their learning needs it is not as clear that they realise how much their future learning will depend on their own inner resources. We suggest that more attention be paid to professional identity formation and the development of the physician as a person during these critical transitions. PMID:26164285

  5. Some of My Best Friends Are Old: A Qualitative Exploration of Medical Students' Interest in Geriatrics

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

    This paper provides insight into the reasons underlying medical students' interest in geriatrics. Semi-structured interviews, informed by attitude theory, were conducted with first-year medical students who indicated that they were not interested in geriatric medicine ( n =10) and those who indicated that they were moderately to very interested in…

  6. Some of My Best Friends Are Old: A Qualitative Exploration of Medical Students' Interest in Geriatrics

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

    This paper provides insight into the reasons underlying medical students' interest in geriatrics. Semi-structured interviews, informed by attitude theory, were conducted with first-year medical students who indicated that they were not interested in geriatric medicine and those who indicated that they were moderately to very interested in…

  7. Physician Assistant Attitude and Expressed Intent to Work with Geriatric Patients

    ERIC Educational Resources Information Center

    Woolsey, Lisa J.

    2007-01-01

    This study evaluated the attitudes of physician assistant students (PAS) and practicing physician assistants (PA) toward geriatric patients and the expressed intent of PAS and practicing PAs toward practicing in the specialized field of geriatric medicine using a cross-sectional study design. The 233 participants each completed a questionnaire…

  8. Dermatoses in geriatric patients.

    PubMed

    Kelly, R

    1977-01-01

    Geriatric patients, though they may present many of the dermatological problems occurring throughout adult life, show a greater incidence of the degenerative skin changes consequent on sun exposure in the form of collagen degeneration, solar keratoses, keratoacanthoma and skin cancer. The benign, precancerous and malignant skin tumours, the various types of eczema, senile pruritus and certain other conditions will be discussed. PMID:140650

  9. Geriatric Live Interactive Teleconferencing.

    ERIC Educational Resources Information Center

    Parham, Iris A.; Wood, Joan

    1985-01-01

    This document includes a successful model for implementing educational teleconferencing, the Geriatric Live Interactive Teleconferencing program at Virginia Commonwealth University (VCU). As a vehicle for continuing professional education, teleconferencing can transmit the latest information to large numbers of health professionals in a variety of…

  10. Geriatric Service Worker.

    ERIC Educational Resources Information Center

    Seton Hill Coll., Greensburg, PA.

    This curriculum for training geriatric service workers is designed to incorporate additional communication and group skills along with the basic knowledge and skills necessary to work with older adults. The curriculum is organized in four modules. Each module is assigned a time frame and a credit unit base. The modules are divided into four major…

  11. Modified Team-Based Learning in an Ophthalmology Clerkship in China

    PubMed Central

    Zhou, Yuxian; Ao, Yong; Xin, Wei; Jia, Yu; Yang, Ying; Cai, Yu; Xu, Chaochao; Yang, Yangfan; Lin, Haotian

    2016-01-01

    Objective Team-based learning (TBL) is an increasingly popular teaching method in medical education. However, TBL hasn’t been well-studied in the ophthalmology clerkship context. This study was to examine the impact of modified TBL in such context and to assess the student evaluations of TBL. Methods Ninety-nine students of an 8-year clinical medicine program from Zhongshan Ophthalmic Centre, Sun Yat-sen University, were randomly divided into four sequential units and assigned to six teams with the same faculty. The one-week ophthalmology clerkship module included traditional lectures, gross anatomy and a TBL module. The effects of the TBL module on student performance were measured by the Individual Readiness Assurance Test (IRAT), the Group Readiness Assurance Test (GRAT), the Group Application Problem (GAP) and final examination scores (FESs). Students’ evaluations of TBL were measured by a 16-item questionnaire. IRAT and GRAT scores were compared using a paired t-test. One-way analysis of variance (ANOVA) and subgroup analysis compared the effects among quartiles that were stratified by the Basic Ophthalmology Levels (BOLs). The BOLs were evaluated before the ophthalmology clerkship. Results In TBL classes, the GRAT scores were significantly higher than the IRAT scores in both the full example and the BOL-stratified groups. It highlighted the advantages of TBL compared to the individual learning. Quartile-stratified ANOVA comparisons showed significant differences at FES scores (P < 0.01). In terms to IRAT, GRAT and GAP scores, there was no significant result. Moreover, IRAT scores only significantly differed between the first and fourth groups. The FES scores of the first three groups are significantly higher than the fourth group. Gender-specific differences were significant in FES but not the IRAT. Overall, 57.65% of student respondents agreed that TBL was helpful. Male students tended to rate TBL higher than female students. Conclusion The application of modified TBL to the ophthalmology clerkship curriculum improved students’ performance and increased students’ engagement and satisfaction. TBL should be further optimized and developed to enhance the educational outcomes among multi-BOLs medical students. PMID:27100286

  12. Geriatric Telemedicine: Background and Evidence for Telemedicine as a Way to Address the Challenges of Geriatrics

    PubMed Central

    2015-01-01

    Objectives The global population of elderly people is increasing at a remarkable rate, which may be expected to continue for some time. Older patients require more care, and with the current model of care delivery, the costs may be expected to rise, although higher cost is unsustainable. For this reason, a new pattern of practice is needed. Telemedicine will be presented as a highly effective and necessary tool in geriatrics. Methods This review will present some of the background and evidence for telemedicine as a way to address the challenges of geriatrics through geriatric telemedicine. Some of the evidence for the value of telemedicine as a tool for physicians and healthcare systems is presented. Results Telemedicine offers many means to address the problems of geriatric care in creative ways. The use of electronic medicine, telecommunications, and information management has now found its way into the very fabric of health care. The use of telemedicine is a fait accompli in much of the world, and it continues to have an increasing role deeply imbedded in our electronic practices coupled with social media. Conclusions The evidence for successful incorporation of telemedicine into practice is abundant and continues to accrue. This is a great opportunity for medical practice to evolve to new levels of engagement with patients and new levels of attainment in terms of quality care. PMID:26618027

  13. Mapping Students Clinical Experiences to Pediatric Clerkship Goals

    PubMed Central

    Lee, Aaron; Sharkey, Angela; McGann, Kathleen; Sumner, Walton

    2006-01-01

    In anticipation of new LCME accreditation requirements, our third year clerkship students began tracking pediatric clinical experiences using a hand-held Electronic Student Encounter Log (ESEL) in June 2005. ESEL was tailored to support rapid documentation of diseases seen at a pediatric tertiary care hospital, while retaining access to primary care diagnoses. We matched encounters that 37 students documented to experiences that fulfill the pediatric clerkships 19 educational goals. We discovered omissions in both ESEL and the goal definitions. No student documented meeting all goals, and no goal was met by all students. Handheld encounter logs are useful for tracking clinical experiences. Logs, logging instructions, and goals require regular compatibility checks. PMID:17238622

  14. [Specificities of pneumonia in geriatrics].

    PubMed

    Pepersack, T

    2014-09-01

    Pneumonia is a major cause of morbidity and mortality leading to a high rate of hospitalization especially in theelderly. It is often a sign of frailty and is associated with a poor prognosis. However, taking into account the geriatric specificities (risk factors, atypical clinical presentations with "geriatric syndromes", ethical debate) using an interdisciplinary and a comprehensive geriatric approach remains an important responsibility of the general practitionner. This article summarizes these specificities and offers interventions targeted on the characteristics of elderly patients. PMID:25675645

  15. Strength and influence of geriatrics departments in academic health centers.

    PubMed

    Bernard, Marie A; Blanchette, Patricia L; Brummel-Smith, Kenneth

    2009-05-01

    The United States is establishing new medical schools and increasing class size by 30% in response to the predicted increased needs of the baby boom generation, which will retire soon and live longer than prior generations. Society in general and the medical profession in particular are ill equipped to care for the special needs of the elderly. Since the early 1980s, departments of geriatric medicine have been developed in the United States. However, the prevailing U.S. system for the training of physicians in geriatrics is through sections, divisions, or institutes. This article reviews the advantages and disadvantages of departments of geriatrics, using case examples from three (University of Oklahoma College of Medicine, Florida State University College of Medicine, and University of Hawaii at Mnoa John A. Burns School of Medicine) of the extant 11 medical schools in the United States with departments of geriatrics. Commonalities among the three departments include a seat at the planning table in academic life, equal treatment and collaboration with other departments in academic and research program development, and direct access to key decision makers and opportunities for negotiation for funds. Each department has outreach to all undergraduate medical students through its training program. All three departments were launched through the investment of significant resources obtained both internally and externally. The challenge for the future will be to definitively demonstrate the efficacy of the department model versus the more prevalent section, division, and institute approach to training physicians to care for the elderly. PMID:19704196

  16. [Geriatric rehabilitation in Germany: service provision policy and structural aspects from a statutory health insurance perspective].

    PubMed

    Leistner, K; Bublitz, T

    2004-10-01

    The so-called shifting of paradigm in medicine has inevitably led to an increasing importance of medical rehabilitation, especially geriatric rehabilitation, within the system of medical care in the Federal Republic of Germany. Nationally valid guidelines for assessing the indication of geriatric rehabilitation and for recommending options for appropriate allocation have been elaborated within the framework of the German statutory health insurance system. In addition, manpower and equipment requirements for ambulatory geriatric rehabilitation facilities have been agreed on. These guidelines include clarifications concerning the following: definition of the geriatric patient; definition of the patient in need of geriatric rehabilitation; demarcation of geriatric rehabilitation from organ-specific rehabilitation; operationalization of assessment procedures and allocation recommendations concerning geriatric rehabilitation; requirements profiles for ambulatory geriatric rehabilitation facilities. Essential prerequisites for successful implementation of these national standards are among others: turning towards the bio-psycho-social model of health and disease advocated by the World Health Organization; overcoming the traditional deficit model of aging and old-age in favour of a resource-oriented approach in service-provision policies; rejecting the one-sided fiscal thinking in the current debate over service-provision policies in geriatric rehabilitation. PMID:15472788

  17. [Urosepsis in Geriatric Patients].

    PubMed

    Heppner, H J; Yapan, F; Wiedemann, A

    2016-02-01

    Due to the demographic shift, increasing numbers of geriatric patients are admitted to acute care hospitals of all levels of care. This means that special challenges must be met in the medical care and management of these patients.Immunosenescence and multimorbidity make elderly patients vulnerable to infectious diseases. Urinary tract infections range from "simple" cystitis to pyelonephritis and urosepsis and, at 25%, are the second most common form of infection in geriatric patients. It is often difficult to make a diagnosis because typical symptoms do not always occur. Urosepsis, a hyperactive and uncontrolled immune response of the organism due to exogenous damage, is based on bacterial infection of the urogenital tract. Urinary retention, immunosuppressive medication, malignancy, diabetes mellitus and renal or prostatic processes promote the risk for urosepsis. Complicated urosepsis additionally comprises a structural or functional abnormality, including ureteral obstruction. Risk factors for urosepsis are urinary incontinence, an indwelling urinary catheter, hydronephrosis or ureteral calculi. Patients suffering from diabetes mellitus are also at a higher risk for urosepsis. When diagnosing elderly patients, one has to consider that the classic symptoms can be masked by multimorbidity, or septic encephalopathy and acute confusion (delirium) may be the only symptoms. Body temperature is lower in elderly patients and does not necessarily rise to 38°C or more in the acute phase. In patients older than 75 years who are suspicious for sepsis, temperatures as low as 37.4°C should be rated as fever. Treatment of urosepsis basically includes clearing the focus, antimicrobial treatment, stabilisation of circulation and replacement of failed organ functions. Initial empiric antibiotic treatment, depending on local resistance, should be done with acylaminopenicilline and beta-lactamase inhibitors (e. g. piperacillin/combactam or tazobactam or group 3 cephalosporins (e. g. cefotaxim). In case of intolerance, fluoroquinolone with high urinary excretion or carbapenem can be used. Also multidrug resistant germs are of importance for urosepsis and require appropriate initial antibiotic treatment.The multimorbidity of geriatric patients puts them at risk for a severe course of infectious diseases. Early identification of high-risk patients and geriatric expert monitoring in intensive care units may assist intensive care physicians. Treatment success in intensive care can be maintained by early geriatric acute rehabilitation. This requires all those involved to enter into an interdisciplinary and interprofessional dialogue. PMID:26916045

  18. Perceived health and geriatric risk stratification

    PubMed Central

    Bluestein, Daniel; Rutledge, Carolyn M.

    2006-01-01

    OBJECTIVE To examine the association between perceived health and self-reported presence of certain geriatric conditions. Perceived health (the way people rate their own health) is a summary measure of health status that predicts functional decline, health care use, and mortality, but has not been examined as a measure of the prevalence of key geriatric conditions among older adults. DESIGN Cross-sectional surveys addressing perceived health and other study variables were mailed to practice patients. SETTING An urban university-based family medicine residency program. PARTICIPANTS In a random sample of 400 patients (from 1327 potential participants) older than 65 years (excluding those with known dementia), more than half (262) responded with usable surveys. MAIN OUTCOME MEASURES Self-reported geriatric syndromes, such as perceived memory loss, depression, falls, incontinence, weight loss, problems with walking, and difficulties with instrumental activities of daily living. RESULTS Of 262 respondents, 102 reported that they perceived their health as poor or fair and were much more likely than people who perceived their health as robust (good, very good, or excellent) to report memory impairment (49.6% vs 23.1%), depression (38.0% vs 13.5%), falls (26.5% vs 12.5%), incontinence (48.5% vs 34.6%), weight loss (33.3% vs 15.4%), needing help with walking (27.3% vs 13.1%), and difficulties with activities of daily living (57.6% vs 24.4%). CONCLUSION These results support the hypothesis that assessment of perceived health can help differentiate low-risk elderly people requiring usual surveillance for geriatric conditions from high-risk elderly people who require timely evaluation and management. PMID:17327894

  19. The impact of medical issues in inpatient geriatric psychiatry.

    PubMed

    Inventor, Ben Remor E; Henricks, John; Rodman, Leslie; Imel, Joel; Holemon, Lance; Hernandez, Fernando

    2005-01-01

    At an advanced age, serious medical and psychiatric illnesses frequently coalesce. Often, the need for admission to inpatient geriatric psychiatric care arises from coexisting medical problems. While cognitive and behavioral interventions are important, the complexity of physical comorbidities usually becomes the focus of hospitalization and requires intensive medical treatments. This paper describes adaptations made in one metropolitan geriatric psychiatry unit in order to better treat complex patients who experience both medical and psychiatric illness. The need for all members of the interdisciplinary team to expand their practice and the importance of complementary approaches of psychiatry and medicine are emphasized. PMID:15842104

  20. Do Geriatricians Stay in Geriatrics?

    ERIC Educational Resources Information Center

    Shah, Uday; Aung, Myo; Chan, Susanna; Wolfklein, Gisele

    2006-01-01

    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…

  1. Care of the geriatric rabbit.

    PubMed

    Lennox, Angela M

    2010-01-01

    The average life span reported in laboratory and lay literature for the domestic rabbit is 5 to 10 years. The author and other veterinarians are now regularly seeing rabbits living to 9 or 10 years, the oldest reported in the author's practice being 14 years. Rabbits are herbivorous prey species with continually growing (elodont) teeth. This feature allows the geriatric rabbit to possess teeth that are essentially "new", a distinct advantage over geriatric carnivores. Expanded longevity, while generally desirable, necessarily accompanies an increase in geriatric disorders. This article examines the spectrum of disease that can affect the geriatric rabbit as well as crucial factors concerning the clinical management of the animal up to the end of its life. An improved understanding of geriatric disorders in pet rabbits allows early recognition and the opportunity to improve quality of life. PMID:20159546

  2. Medical Students' Interest in Child Psychiatry: A Clerkship Intervention

    ERIC Educational Resources Information Center

    Martin, Vicki L.; Bennett, David S.; Pitale, Maria

    2007-01-01

    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…

  3. Student Experiences with Competency Domains during a Psychiatry Clerkship

    ERIC Educational Resources Information Center

    West, Donald A.; Nierenberg, David W.

    2009-01-01

    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…

  4. Geriatric assessment teams.

    PubMed

    Campbell, L J; Cole, K D

    1987-02-01

    In geriatric care, a form of teamwork is the recommended modality because of the complex biopsychosocial needs of the patient. The goal of geriatric assessment programs is to establish an intensive assessment of older adults which requires the competencies of several coordinated disciplines. Not only do teams have the capacity to assess patients in much greater depth but also patients share different information with different providers. The composition of the team is dictated by the needs of the patient population in accordance with resources available. Next, one must identify a method of team practice in order for interactions to take place. The method of functioning determines what kind of team it is, ranging from independent functioning with minimal formal interfacing to interdependent activity interspersed with formal and informal interactions. In initiating a geriatric assessment program, one needs to determine which tasks demand interdisciplinary collaboration, which require interdisciplinary consultation, and which can be performed using a matrix or extended team model. In this model, the core team is supplemented by other disciplines as determined by the team, predicated on patient problems. Teams can profit from training, which can help with choosing an appropriate model, establishing a manual of procedure, and managing interactive issues and problems. This can occur early in the team's formation, or when a team takes on new members. The minimal level of team development would include establishing program goals, delineating professional responsibilities and roles, and implementing a system for exchanging and documenting information about patient plans. Saving input to share only in team meeting is inefficient, so health care teams need to recognize the importance of informal interchanges. It is still a matter of conjecture about what team works best with which patients under what circumstances or conditions. Multiple randomized clinical trials with teams will give us more information in this regard. In the meantime, organizers of geriatric assessment programs will have to make decisions based on clinical practice in the team development field and extrapolations from related health care team studies. PMID:3545426

  5. Standpoints of traditional Persian physicians on geriatric nutrition.

    PubMed

    Emami, Morteza; Nazarinia, Mohammad Ali; Rezaeizadeh, Hussein; Zarshenas, Mohammad M

    2014-10-01

    The present article aimed to compile information on the nutritional management for geriatric people. Popular textbooks of Persian medicine from 10th to 18th century were studied to derive relative viewpoints and considerations. The temperament, which is defined as the combination of 4 main elements (fire, air, water, and soil) and 4 humors made subsequently (black bile, yellow bile, phlegm, and blood), changes during age periods. Imbalance in proportional amounts of humors in elderly should be corrected with food and medicaments having opposite nature to the current condition. Traditional foods included mostly well-cooked soups, pottages, and porridges containing fresh sheep or chicken meat. Mono-ingredient foods were also administered according to their medical properties. Nutritional recommendations were also concerned with geriatrics' physiological conditions such as constipation, sleep disorders, and memory deficits. Many of traditional geriatric nutritional requirements are relevant in the present day. However, there are still notes that may be beneficial for consideration. PMID:25053755

  6. Teaching geriatric fellows how to teach: a needs assessment targeting geriatrics fellowship program directors.

    PubMed

    Rivera, Veronica; Yukawa, Michi; Aronson, Louise; Widera, Eric

    2014-12-01

    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

  7. 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

    2008-01-01

    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…

  8. At the Precipice: A Prospective Exploration of Medical Students' Expectations of the Pre-Clerkship to Clerkship Transition

    ERIC Educational Resources Information Center

    Soo, Jason; Brett-MacLean, Pamela; Cave, Marie-Therese; Oswald, Anna

    2016-01-01

    Medical learners face many challenging transitions. We prospectively explored students' perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition

  9. At the Precipice: A Prospective Exploration of Medical Students' Expectations of the Pre-Clerkship to Clerkship Transition

    ERIC Educational Resources Information Center

    Soo, Jason; Brett-MacLean, Pamela; Cave, Marie-Therese; Oswald, Anna

    2016-01-01

    Medical learners face many challenging transitions. We prospectively explored students' perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition…

  10. The learning environment in the obstetrics and gynecology clerkship: an exploratory study of students' perceptions before and after the clerkship

    PubMed Central

    Baecher-Lind, Laura E.; Chang, Katherine; Blanco, Maria A.

    2015-01-01

    For reasons that remain not entirely clear, Obstetrics and Gynecology (Ob/Gyn) clerkships often exhibit comparatively higher rates of medical student mistreatment. To explore perceptions of our local learning environment, focus groups were held with students yet to start (pre-students) and students having completed (post-students) their Ob/Gyn clerkship. Topics of discussion included learning expectations and experiences, perceptions of mistreatment, and suggestions for improving the learning environment and student treatment. Using a naturalistic approach, we conducted a conventional content analysis to identify emergent themes. Nine pre-students and nine post-students participated. While pre-students anticipated being actively engaged, they also expected – based on peer accounts – to be subject to an unwelcoming learning environment on the Ob/Gyn clerkship, despite working hard to become team members. Due to patient advocacy and protection concerns, post-students reported low levels of student involvement and, subsequently, an overall passive learning experience. Students from both groups offered valuable suggestions for improving the learning environment and student treatment. The sensitive nature of Ob/Gyn clinical encounters may lead to overprotective behaviors that contribute to students feeling mistreated and excluded from patient care and team membership. Students’ experiences during Ob/Gyn clerkships could be improved by better balancing patient advocacy and student involvement. Practical implications to address these issues are offered. PMID:26080798

  11. [Antipsychotics in geriatric institutions].

    PubMed

    Szulik, Judith

    2007-01-01

    The present paper approaches the use of antipsychotics in elder people in general, and particularly in geriatric institutions. During the last few years, prescription of antipsychotics in geriatric institutions increased, especially because of the availability of the atypicals, and their use was extended beyond the indications these drugs had been approved for. In dementia they are suggested for treatment of behavioral symptoms, despite having been approved only for cases of aggressiveness and risk of damage. There is a common tendency of perpetuating antipsychotic medication in elder people, with its consequent collateral effects as well. Few years ago, the increase of both risk of cerebrovascular events and of mortality in dementia patients treated with atypical agents was noticed. This generated controversy regarding their use in those kind of patients. Diverse factors associated to caregivers affect the decision of prescribing an antipsychotic in elder people. Non-pharmacological interventions are the first choice when treating behavioral symptoms; pharmacological interventions must take place with the lowest doses possible, with limited durations. PMID:18273435

  12. Geriatrics Education Team Model Results in Sustained Geriatrics Training in 15 Residency and Fellowship Programs and Scholarship.

    PubMed

    Denson, Steven; Simpson, Deborah; Denson, Kathryn; Brown, Diane; Manzi, Gabriel; Rehm, Judith; Wessel, Bambi; Duthie, Edmund H

    2016-04-01

    Caring for the growing elderly population will require specialty and subspecialty physicians who have not completed geriatric medicine fellowship training to participate actively in patient care. To meet this workforce demand, a sustainable approach to integrating geriatrics into specialty and subspecialty graduate medical education training is needed. This article describes the use of a geriatrics education team (GET) model to develop, implement, and sustain specialty-specific geriatrics curricula using a systematic process of team formation and needs assessment through evaluation, with a unique focus on developing curricular interventions that are meaningful to each specialty and satisfy training, scholarship, and regulatory requirements. The GET model and associated results from 15 specialty residency and fellowship training programs over a 4-year period include 93% curriculum sustainability after initial implementation, more than half of the programs introducing additional geriatrics education, and more than 80% of specialty GETs fulfilling their scholarship requirements through their curriculum dissemination. Win-wins and barriers encountered in using the GET model, along with the model's efficacy in curriculum development, sustainability, and dissemination, are summarized. PMID:27021702

  13. Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

    PubMed Central

    Carpenter, Christopher R; Griffey, Richard T; Stark, Susan; Coopersmith, Craig M; Gage, Brian F

    2011-01-01

    Introduction The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods This was a single-center emergency department (ED) survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. PMID:22224145

  14. A national radiation oncology medical student clerkship survey: Didactic curricular components increase confidence in clinical competency

    PubMed Central

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    Purpose/Objectives Students applying to radiation oncology residency programs complete one 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 three 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% (70/188). Respondents reported 191 unique clerkship experiences. 27% of respondents (19/70) completed at least one 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 = 0.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman’s rho p = 0.48) or confidence to function as a first year resident (Spearman’s rho p = 0.43). 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. PMID:24331651

  15. A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

    SciTech Connect

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    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 ρ P=.48) or confidence to function as a first year resident (Spearman ρ 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.

  16. The Columbia Cooperative Aging Program: an interdisciplinary and interdepartmental approach to geriatric education for medical interns.

    PubMed

    Maurer, Mathew S; Costley, Alex W; Miller, Patricia A; McCabe, Sigrid; Dubin, Shelly; Cheng, Huai; Varela-Burstein, Ellyn; Lam, Binh; Irvine, Craig; Page, Kerrianne P; Ridge, Gerald; Gurland, Barry

    2006-03-01

    Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns. PMID:16551323

  17. The Geriatrics in Primary Care Demonstration: Integrating Comprehensive Geriatric Care into the Medical Home: Preliminary Data.

    PubMed

    Engel, Peter A; Spencer, Jacqueline; Paul, Todd; Boardman, Judith B

    2016-04-01

    Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a significant reduction in subspecialty clinic use. Model simplicity and flexibility facilitated ready implementation. PMID:27100583

  18. Home geriatric physiological measurements.

    PubMed

    Tamura, Toshiyo

    2012-10-01

    In an ageing society, the elderly can be monitored with numerous physiological, physical and passive devices. Sensors can be installed in the home for continuous mobility assistance and unobtrusive disease prevention. This review presents several modern sensors, which improve the quality of life and assist the elderly, disabled people and their caregivers. The main concept of geriatric sensors is that they are capable of providing assistance without limiting or disturbing the subject's daily routine, giving him or her greater comfort, pleasure and well-being. Furthermore, this review includes associated technologies of wearable/implantable monitoring systems and the 'smart-house' project. This review concludes by discussing future challenges of the future aged society. PMID:23011097

  19. Teaching Programs in Geriatric Optometry.

    ERIC Educational Resources Information Center

    Rosenbloom, Albert A.

    1985-01-01

    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)

  20. Spirituality in geriatric palliative care.

    PubMed

    Puchalski, Christina M

    2015-05-01

    This article presents an overview of spirituality as an essential domain of geriatrics palliative care, and provides guidelines for clinicians to diagnose spiritual distress and to integrate spirituality into their clinical practice. PMID:25920059

  1. Trauma in the geriatric population.

    PubMed

    Maxwell, Cathy A

    2015-06-01

    Injury in older adults is a looming public health crisis. This article provides a broad overview of geriatric trauma across the continuum of care. After a review of the epidemiology of geriatric trauma, optimal approaches to patient care are presented for triage and transport, trauma team activation and initial assessment, inpatient management, and injury prevention. Special emphasis is given to assessment of frailty, advanced care planning, and transitions of care. PMID:25981722

  2. Mapping students' clinical experiences to pediatric clerkship goals.

    PubMed

    Lee, Aaron; Sharkey, Angela; McGann, Kathleen; Sumner, Walton

    2006-01-01

    In anticipation of new LCME accreditation requirements, our third year clerkship students began tracking pediatric clinical experiences using a hand-held Electronic Student Encounter Log (ESEL) in June 2005. ESEL was tailored to support rapid documentation of diseases seen at a pediatric tertiary care hospital, while retaining access to primary care diagnoses. We matched encounters that 37 students documented to experiences that fulfill the pediatric clerkship's 19 educational goals. We discovered omissions in both ESEL and the goal definitions. No student documented meeting all goals, and no goal was met by all students. Handheld encounter logs are useful for tracking clinical experiences. Logs, logging instructions, and goals require regular compatibility checks. PMID:17238622

  3. 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

    2010-01-01

    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…

  4. Shorter Psychiatry Clerkship Length Is Associated with Lower NBME Psychiatry Shelf Exam Performance

    ERIC Educational Resources Information Center

    Bostwick, J. Michael; Alexander, Cara

    2012-01-01

    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…

  5. Canadian Otolaryngology - Head and Neck Surgery clerkship curricula: evolving toward tomorrow’s learners

    PubMed Central

    2013-01-01

    Background Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum. Methods An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers. Results Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources. Conclusions Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience. PMID:23663703

  6. Creating Stories to Live By: Caring and Professional Identity Formation in a Longitudinal Integrated Clerkship

    ERIC Educational Resources Information Center

    Konkin, Jill; Suddards, Carol

    2012-01-01

    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…

  7. 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.

    2010-01-01

    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…

  8. 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.

    2010-01-01

    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

  9. A Description and Four-Year Analysis of a Clinical Clerkship Evaluation System.

    ERIC Educational Resources Information Center

    And Others; Littlefield, John H.

    1981-01-01

    Major issues related to evaluating student performance in clinical clerkships are reviewed, and the development of a clerkship evaluation system that attempts to deal with each issue is described. Three evaluation methods are utilized: multiple choice examination, oral examination, and ward ratings. (Author/MLW)

  10. Models of Care in Geriatric Oncology

    PubMed Central

    Magnuson, A.; Dale, W.; Mohile, S.

    2014-01-01

    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

  11. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    PubMed Central

    O'Donovan, A.; Mohile, S.G.; Leech, M.

    2015-01-01

    Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457

  12. Getting Real: Embracing the Conditions of the Third-Year Clerkship and Reimagining the Curriculum to Enable Deliberate Practice.

    PubMed

    Lee Klamen, Debra

    2015-10-01

    There are many calls in the literature for changes in how medical students are educated. Although many curricular innovations have been attempted, a look at the theory behind how complex skills are learned provides useful information to guide new curriculum developments. The requirement of deliberate practice as the road map for success in the learning of clinical skills suggests that perhaps the current clinical milieu is not an optimal place for medical students to learn. The idiosyncrasy inherent in the dramatically changed medical landscape of the last 20 years makes it difficult for such practice to occur; the apprentice model of legitimate peripheral participation in a community of practice as it used to exist does no longer. Indeed, current workplace environments are at odds with the needs of medical students. Overwhelming numbers of goals and objectives in existing third-year clerkships serve as wish lists of what students should learn. They should be replaced by a systematic, longitudinal curriculum in which all students can be guaranteed to have encountered the core clinical competencies as defined. Moving the goals and objectives of the current clerkships to a longitudinal, spiral curricular format frees up clinical time in the third year to be used for students to find their future specialty and socialize into medicine. Doing so allows for an opportunity for students to spend extended time in areas of their interest. Moving to such a new curriculum format maximizes and optimizes learning while embracing the reality of current clinical workplace environments. PMID:25901873

  13. Geriatric Dentistry in the Predoctoral Curriculum.

    ERIC Educational Resources Information Center

    Moshman, Jack; And Others

    1985-01-01

    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)

  14. A Compendium of Objectives for Geriatric Dentistry.

    ERIC Educational Resources Information Center

    Kress, Gerard C. Jr.; Vidmar, Gordon C.

    1985-01-01

    Results of a survey of geriatric dentistry specialists concerning the competencies required of geriatric dentists and the relative importance of those skills in five settings (dental school, general practice residency, prosthodontic specialty programs, geriatric fellowship programs, and continuing education) are reported. (MSE)

  15. Geriatric assessment for oncologists

    PubMed Central

    Korc-Grodzicki, Beatriz; Holmes, Holly M.; Shahrokni, Armin

    2015-01-01

    The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient’s physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment (GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed. PMID:26779363

  16. Preoperative Assessment of Geriatric Patients.

    PubMed

    Knittel, Justin G; Wildes, Troy S

    2016-03-01

    Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient. PMID:26927746

  17. Medicines

    MedlinePlus

    ... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...

  18. The clerkship in public health: a positive experience.

    PubMed

    Drusin, L M; Goss, M E; Horowitz, S V; Reader, G G

    1992-01-01

    Cornell University Medical College's required third-year clerkship in public health offers a unique educational experience well received by faculty and students. Within a two-week period, a combination of field trips, seminars, lectures, required reading, and a research paper enables students to gain familiarity with a broad range of issues by placing them in situations exposing them to relevant problems and solutions. Nearly all students find some aspect of either the field trips or seminars provocative. Some are motivated to plan follow-up electives. A similar course using local resources could be offered elsewhere. PMID:1576002

  19. Geriatric Optometry Programs of Promise.

    ERIC Educational Resources Information Center

    Verma, Satya B.

    1985-01-01

    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)

  20. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

    Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.

    2010-01-01

    The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators…

  1. Family Medicine Training in the Care of Older Adults--Has the Retreat Been Sounded?

    ERIC Educational Resources Information Center

    Mouton, Charles P.; Parker, Robert W.

    2003-01-01

    Discusses the trend away from geriatrics training in family medicine residency despite the growing need in society. Asserts that family medicine is failing to seize an opportunity to advance the care of older adults and discusses what would constitute acceptable training in geriatrics and how it should fit into the family medicine curriculum. (EV)

  2. Comprehensive geriatric assessment in the emergency department.

    PubMed

    Ellis, Graham; Marshall, Trudi; Ritchie, Claire

    2014-01-01

    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

  3. Comprehensive geriatric assessment in the emergency department

    PubMed Central

    Ellis, Graham; Marshall, Trudi; Ritchie, Claire

    2014-01-01

    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

  4. Integrating Prevention Education into the Medical School Curriculum: The Role of Departments of Family Medicine.

    ERIC Educational Resources Information Center

    Stine, Curtis; Kohrs, Francis P.; Little, David N.; Kaprielian, Victoria; Gatipon, Betty B.; Haq, Cynthia

    2000-01-01

    Discusses the role of departments of family medicine in teaching preventive medicine through required clinical experiences, required nonclinical courses, electives, collaborative interdisciplinary clerkships, and interdisciplinary nonclinical courses. Offers examples of innovative programs at the Universities of Michigan, Wisconsin, Vermont,…

  5. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes toward Homeless Persons

    ERIC Educational Resources Information Center

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    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

  6. Integration of Women's Health into an Internal Medicine Core Curriculum for Medical Students.

    ERIC Educational Resources Information Center

    Nicolette, JoDean; Jacobs, Michael D.

    2000-01-01

    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.…

  7. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes toward Homeless Persons

    ERIC Educational Resources Information Center

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    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…

  8. [Geriatric intervention in oncology for elderly patients].

    PubMed

    Saint-Jean, O; LeGuen, J

    2015-10-01

    Half of all cancers occur in patients older than 70 years. National cancer plans in France promote the emergence of geriatric oncology, whose aim is that every elder cancer patient receives a pertinent treatment, according to his frailty. Geriatric intervention has been evaluated in various conditions or patients since 30 years. Meta-analysis has shown the benefits on autonomy and mortality. But benefits are related to the organization of geriatric care, especially when integrated care is provided. Literature on geriatric oncology is relatively poor. But it is certain that a geriatric comprehensive assessment provided a lot of important information for the care of cancer patients, leading to a modification of cancer treatment in many cases. Randomized trials will soon begin to evaluate the benefits of geriatric integrated care for elder cancer patients, in terms of mortality and quality of life. Actually, in oncogeriatic coordination units, pilot organizations are developed for the satisfaction of patients and professionals. PMID:26344438

  9. Teaching Medical Students About Disability in Family Medicine

    PubMed Central

    Graham, Catherine Leigh; Brown, Rachel S.; Zhen, Huiling; McDermott, Suzanne

    2015-01-01

    We investigated whether a unique didactic focusing on delivering health care to patients with disabilities (PWDs) impacts medical students’ knowledge of specific disabilities and related concerns, attitudes about barriers to this populations’ health care, and behavior during typical primary care visits with PWDs. A 90-minute session for students during their third-year family medicine clerkship addressed clinical considerations for patients with mobility and cognitive impairments. Questionnaires were administered to students at the beginning and completion of the clerkship. Analyses of 71 matched questionnaires reveal that knowledge and attitudes were positively impacted. PMID:19724936

  10. Geriatric Depression in Primary Care

    PubMed Central

    Park, Mijung; Unützer, Jürgen

    2011-01-01

    Primary care settings present important opportunities for the detection and management of depression in older adults. As many as 10 % of older adults presenting in primary care have clinically significant depression, but only about half are recognized and only one in five depressed older adults receive effective treatment in primary care. We review common barriers to effective treatment such as atypical clinical presentations and comorbid medical conditions that are common in older adults. We identify treatment strategies such as measurement-based stepped care and collaborative care that can substantially improve the effectiveness of treatment in this setting and we highlight opportunities for addressing health disparities in geriatric depression care. We also point out the importance of engaging and supporting family caregivers of depressed older adults. We conclude by identifying three strategic areas to improve the treatment of geriatric depression in primary care: activation and engagement of patients and family members, health care provider training, and broader system changes. PMID:21536169

  11. Research advances in geriatric depression

    PubMed Central

    ALEXOPOULOS, GEORGE S.; KELLY JR., ROBERT E.

    2009-01-01

    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

  12. 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.

    2006-01-01

    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…

  13. [Pain Management in geriatric patients].

    PubMed

    Eiche, Jürgen; Schache, Florian

    2016-04-01

    Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life. These facts shows the relevance of a sufficient pain therapy in geriatric patients. Nevertheless, on account of existing comorbidity, polypharmacy as well as of impaired organ function, the pharmacological pain therapy in old patients also poses a potential hazard. Although pain prevalence is higher with geriatric than with younger patients, significantly less analgesics are prescribed in the elderly population. This results from existing uncertainties at the treating doctors as well as the complicated pain capture, in particular with cognitive affected patients. The present article should indicate options of treatment for geriatric pain patients. PMID:27123730

  14. Bloodless surgery in geriatric surgery.

    PubMed

    Guarino, Salvatore; Di Matteo, Filippo; Sorrenti, Salvatore; Greco, Roberto; Nardi, Matteo; Favoriti, Pasqualino; De Antoni, Enrico; Filippini, Angelo; Catania, Antonio

    2014-01-01

    In bloodless surgery a series of measures has to be implemented to reduce the perioperative need for transfusion of whole blood or its components. Jehovah's Witness are the most representative group of patients opting for bloodless surgery as their faith follows strict believes that prohibits receiving blood. Geriatric patients requiring bloodless surgery are even more delicate and represent a challenge for surgeons. The physiological response of the over 65 year population to decreased hemoglobin level is slower and less effective than in young and adult patients. Herby we describe the perioperative protocol implemented in our surgical Department offered to geriatric Jehovah's Witness patients. Preoperative optimization of the patients is the key step in the preparation period. Intraoperative anesthetic and surgical measures are also required along with a strict postoperative follow-up. From our experience, bloodless surgery is feasible in the geriatric population as long as it is performed in specialized centers where a multidisciplinary team is prepared to specifically manage this scenario. Rigorous patients selection and preparation are mandatory. PMID:25183638

  15. The Harvard Medical School-Cambridge integrated clerkship: an innovative model of clinical education.

    PubMed

    Ogur, Barbara; Hirsh, David; Krupat, Edward; Bor, David

    2007-04-01

    The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients. PMID:17414198

  16. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Geriatric parole. 2.78 Section 2.78 Judicial 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. (a) Upon receipt of a...

  17. Trends in Predoctoral Education in Geriatric Dentistry.

    ERIC Educational Resources Information Center

    Saunders, Ralph H.; Yellowitz, Janet A.; Dolan, Teresa A.; Smith, Barbara J.

    1998-01-01

    A survey of 46 United States and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of American Association of Dental Schools and Administration on Aging geriatric dental curricular materials. An increasing number reported geriatric didactic courses, clinical rotations, and…

  18. Trends in Predoctoral Education in Geriatric Dentistry.

    ERIC Educational Resources Information Center

    Saunders, Ralph H.; Yellowitz, Janet A.; Dolan, Teresa A.; Smith, Barbara J.

    1998-01-01

    A survey of 46 United States and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of American Association of Dental Schools and Administration on Aging geriatric dental curricular materials. An increasing number reported geriatric didactic courses, clinical rotations, and

  19. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Geriatric parole. 2.78 Section 2.78 Judicial 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. (a) Upon receipt of a...

  20. Analysis and Management of Geriatric Anxiety.

    ERIC Educational Resources Information Center

    Sallis, James F.; Lichstein, Kenneth L.

    1982-01-01

    Reviews the prevalence, negative health implications, and clinical management of geriatric anxiety. Proposes an interactive model of geriatric anxiety whereby physical disease and anxiety processes enter into reciprocal stimulation as a function of diminished capacity to withstand stress and hypervigilance of stress symptomatology. Outlines…

  1. Enhancing Geriatric Curriculum in Nursing School

    ERIC Educational Resources Information Center

    Collins, Kevin

    2013-01-01

    People are living longer. The average age of the population is increasing, and is expected to keep growing. Any person age 65 and older is now considered "geriatric." However, although growing, this population is not receiving adequate nursing care, and results in increased pain, falls, and even death. Geriatric curriculum is becoming…

  2. Geriatric psychopharmacology: evolution of a discipline.

    PubMed

    Meyers, Barnett S; Jeste, Dilip V

    2010-11-01

    The development of geriatric psychopharmacology was built on advances in geriatric psychiatry nosology and clinical pharmacology and on increased investment in aging research by the National Institute of Mental Health and by academic institutions. Application of the US Food and Drug Administration's geriatric labeling rule provided further impetus. Developments in the knowledge about 3 principal classes of medications (antidepressants, antipsychotics, and treatments for Alzheimer's disease) illustrate the trajectory of geriatric psychopharmacology research. Nonetheless, the loss of information about age effects that has resulted from applying age exclusion criteria in studies limited to either younger adults or geriatric patients is regrettable. Antidepressant trials have moved from studying younger and medically well "geriatric" samples to focusing on "older old" persons and those with significant medical comorbidity including coronary artery disease, cerebrovascular disease, and dementia. Increased specificity is reflected in studies of relationships between specific neuropsychological deficits, specific brain abnormalities, and antidepressant responsiveness. Clinical trials in older adults have demonstrated that the efficacy of antipsychotic medications continues across the lifespan, but that sensitivity to specific side effects changes in older age, with poor tolerability frequently mitigating the benefits of treatment. Treatments for Alzheimer's disease have fallen within the purview of geriatric psychopharmacology. The research focus is increasingly shifting from treatments to slow the course of cognitive decline to studies of early diagnosis and of interventions designed to prevent the development of deficits in vulnerable individuals. The importance of geriatric psychopharmacology will grow further as the average lifespan increases all over the world. PMID:21114947

  3. Voluntary undergraduate technical skills training course to prepare students for clerkship assignment: tutees’ and tutors’ perspectives

    PubMed Central

    2014-01-01

    Background Skills lab training has become a widespread tool in medical education, and nowadays, skills labs are ubiquitous among medical faculties across the world. An increasingly prevalent didactic approach in skills lab teaching is peer-assisted learning (PAL), which has been shown to be not only effective, but can be considered to be on a par with faculty staff-led training. The aim of the study is to determine whether voluntary preclinical skills teaching by peer tutors is a feasible method for preparing medical students for effective workplace learning in clerkships and to investigate both tutees’ and tutors’ attitudes towards such an intervention. Methods A voluntary clerkship preparation skills course was designed and delivered. N = 135 pre-clinical medical students visited the training sessions. N = 10 tutors were trained as skills-lab peer tutors. Voluntary clerkship preparation skills courses as well as tutor training were evaluated by acceptance ratings and pre-post self-assessment ratings. Furthermore, qualitative analyses of skills lab tutors’ attitudes towards the course were conducted following principles of grounded theory. Results Results show that a voluntary clerkship preparation skills course is in high demand, is highly accepted and leads to significant changes in self-assessment ratings. Regarding qualitative analysis of tutor statements, clerkship preparation skills courses were considered to be a helpful and necessary asset to preclinical medical education, which benefits from the tutors’ own clerkship experiences and a high standardization of training. Tutor training is also highly accepted and regarded as an indispensable tool for peer tutors. Conclusions Our study shows that the demand for voluntary competence-oriented clerkship preparation is high, and a peer tutor-led skills course as well as tutor training is well accepted. The focused didactic approach for tutor training is perceived to be effective in preparing tutors for their teaching activity in this context. A prospective study design would be needed to substantiate the results objectively and confirm the effectiveness. PMID:24708782

  4. Laminitis in the geriatric horse.

    PubMed

    Hunt, Robert J

    2002-12-01

    There are few diseases that instill a comparable sense of doom in the mind of a treating veterinarian as laminitis. There is a feeling of cautious optimism when a horse with laminitis responds favorably to treatment. Although this optimism all too often proves false when treating laminitic patients, management of the patient afflicted with chronic laminitis can be rewarding. Through diligent and careful client communication and instruction, many geriatric patients with chronic laminitis can be maintained for years as comfortable companions, for light riding use, or as productive breeding animals. PMID:12516927

  5. Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care

    PubMed Central

    Owusu, Cynthia; Berger, Nathan A

    2015-01-01

    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

  6. Terror Medicine as Part of the Medical School Curriculum

    PubMed Central

    Cole, Leonard A.; Wagner, Katherine; Scott, Sandra; Connell, Nancy D.; Cooper, Arthur; Kennedy, Cheryl Ann; Natal, Brenda; Lamba, Sangeeta

    2014-01-01

    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

  7. Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

    ERIC Educational Resources Information Center

    Adelman, Ronald D.; Ansell, Pamela; Breckman, Risa; Snow, Caitlin E.; Ehrlich, Amy R.; Greene, Michele G.; Greenberg, Debra F.; Raik, Barrie L.; Raymond, Joshua J.; Clabby, John F.; Fields, Suzanne D.; Breznay, Jennifer B.

    2011-01-01

    Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area…

  8. Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

    ERIC Educational Resources Information Center

    Adelman, Ronald D.; Ansell, Pamela; Breckman, Risa; Snow, Caitlin E.; Ehrlich, Amy R.; Greene, Michele G.; Greenberg, Debra F.; Raik, Barrie L.; Raymond, Joshua J.; Clabby, John F.; Fields, Suzanne D.; Breznay, Jennifer B.

    2011-01-01

    Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area

  9. [Implementation of a palliative care concept in a geriatric acute care hospital].

    PubMed

    Hagg-Grün, U; Lukas, A; Sommer, B-N; Klaiber, H-R; Nikolaus, T

    2010-12-01

    To integrate palliative care patients into an acute geriatric ward requires extensive and continuous education and preparation of all participating professionals. It can be a lengthy process to integrate palliative care concepts despite cooperation of the hospital administration. The group of patients to be integrated differs from the patients of regular geriatric wards because of a higher percentage of relatively young oncologic patients and they differ from a regular palliative ward because about 50% are non-oncologic patients, while the average age is much higher than in normal palliative care. It is possible to integrate specialized palliative care into a regular geriatric ward. Patients admitted without palliative intention will benefit the most from ward-integrated palliative care if the treatment aim turns this way. Ward-integrated palliative care can be an integral part of treating geriatric patients in addition to acute geriatric medicine, rehabilitation, and prevention. It can also provide caretakers and patients with the benefits from continuity of treatment and care. PMID:21085974

  10. How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?

    PubMed Central

    Wei, Grant; Arya, Rajiv; Ritz, Z. Trevor; He, Albert S.; Ohman-Strickland, Pamela A.; McCoy, Jonathan V.

    2015-01-01

    Introduction The effect of emergency department (ED) crowding has been recognized as a concern for more than 20 years; its effect on productivity, medical errors, and patient satisfaction has been studied extensively. Little research has reviewed the effect of ED crowding on medical education. Prior studies that have considered this effect have shown no correlation between ED crowding and resident perception of quality of medical education. Objective To determine whether ED crowding, as measured by the National ED Overcrowding Scale (NEDOCS) score, has a quantifiable effect on medical student objective and subjective experiences during emergency medicine (EM) clerkship rotations. Methods We collected end-of-rotation examinations and medical student evaluations for 21 EM rotation blocks between July 2010 and May 2012, with a total of 211 students. NEDOCS scores were calculated for each corresponding period. Weighted regression analyses examined the correlation between components of the medical student evaluation, student test scores, and the NEDOCS score for each period. Results When all 21 rotations are included in the analysis, NEDOCS scores showed a negative correlation with medical student tests scores (regression coefficient= −0.16, p=0.04) and three elements of the rotation evaluation (attending teaching, communication, and systems-based practice; p<0.05). We excluded an outlying NEDOCS score from the analysis and obtained similar results. When the data were controlled for effect of month of the year, only student test score remained significantly correlated with NEDOCS score (p=0.011). No part of the medical student rotation evaluation attained significant correlation with the NEDOCS score (p≥0.34 in all cases). Conclusion ED overcrowding does demonstrate a small but negative association with medical student performance on end-of-rotation examinations. Additional studies are recommended to further evaluate this effect. PMID:26594289

  11. Time to trust: longitudinal integrated clerkships and entrustable professional activities.

    PubMed

    Hirsh, David A; Holmboe, Eric S; ten Cate, Olle

    2014-02-01

    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

  12. Twelve tips for designing and running longitudinal integrated clerkships

    PubMed Central

    Ellaway, Rachel; Graves, Lisa; Berry, Sue; Myhre, Doug; Cummings, Beth-Ann; Konkin, Jill

    2013-01-01

    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

  13. Iranian Medical Students’ Perception of Psychiatry: Before and After a Psychiatry Clerkship

    PubMed Central

    Nejatisafa, Ali-Akbar; Shoar, Saeed; Kaviani, Hosein; Samimi-Ardestani, Mehdi; Shabani, Amir; Esmaeili, Sara; Moghaddam, Yasaman

    2013-01-01

    Objective We aimed to compare the medical students’ attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics. Method In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences) were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65%) completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship. Results Positive response to choose psychiatry as a career was seen in 13.3% and 18.3% before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7%) students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends’ mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49), and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57). Conclusion It may be concluded that exposure to psychiatry clerkship could influence medical students’ opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future career. PMID:23682250

  14. [Geriatrics].

    PubMed

    Büla, Christophe

    2006-01-01

    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

  15. Clinical vignettes in geriatric depression.

    PubMed

    Spoelhof, G David; Davis, Gary L; Licari, Addie

    2011-11-15

    The diagnosis of depression in older patients is often complicated by comorbid conditions, such as cerebrovascular disease or dementia. Tools specific for this age group, such as the Geriatric Depression Scale or the Cornell Scale for Depression in Dementia, may assist in making the diagnosis. Treatment decisions should consider risks associated with medications, such as serotonin syndrome, hyponatremia, falls, fractures, and gastrointestinal bleeding. Older white men with depression are at high risk of suicide. Depression is common after stroke or myocardial infarction, and response to antidepressant treatment has been linked to vascular outcomes. Depression care management is an important adjunct to the use of antidepressant medications. Structured psychotherapy and exercise programs are useful treatments for select patients. PMID:22085669

  16. [Geriatric assessment in the oncology setting].

    PubMed

    Terret, Catherine

    2008-05-28

    The optimal management of elderly patients with cancer includes, besides the tumour assessment, a geriatric evaluation procedure. To date, comprehensive geriatric assessment (CGA) remains the gold standard of evaluation in older patients. To be effective, the process must be performed by a team with special expertise in caring for elderly people, in a specific geriatric unit. Alternative procedures have been developed and studied in the oncology setting, multidimensional geriatric assessment and screening tools. This approach has been developed to help oncologists differentiate the healthy elderly from other older patients whose problems would possibly interfere with cancer treatment and who require a pre-treatment CGA. Studies have shown that healthy older patients derive no advantage from CGA, but benefit from cancer treatment as much as younger patients. PMID:18511362

  17. Structural Neuroimaging Research Methods in Geriatric Depression

    PubMed Central

    Hoptman, Matthew J.; Gunning-Dixon, Faith M.; Murphy, Christopher F.; Lim, Kelvin O.; Alexopoulos, George S.

    2007-01-01

    Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. However, there is evidence that abnormalities in specific brain structures and their interconnections confer vulnerability to the development of late-life depression. Structural magnetic resonance imaging methods can be used to identify and quantify brain abnormalities predisposing to geriatric depression and in prediction of treatment response. This article reviews several techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, magnetization transfer imaging, t2 relaxography, and spectroscopy, that have been used to examine these brain abnormalities with a focus on the type of information obtained by each method as well as each method’s limitations. The authors argue that the available methods provide complementary information and that, when combined judiciously, can increase the knowledge gained from neuroimaging findings and conceptually advance the field of geriatric depression. (Am J Geriatr Psychiatry 2006; 14:812–822) PMID:17001021

  18. [Geriatric health system, economic profit and the debate on euthanasia].

    PubMed

    Wedler, H

    1999-08-01

    Three characteristic developments in modern western societies usually are considered to be independent variables in the ethical discussion:1. An explosion-like increase in medical and social expenditures following a rapid multiplication of old and multiply disabled people in this century. 2. the increasing economic importance of the "health industry", and 3. the "new" debate of euthanasia. All these developments are discussed controversially. The volume of geriatric support is mostly considered to be insufficient, but usually it is restricted by both, scarcity of resources as well as increasing demands to focus on "evidence-based medicine" (which might exclude a lot of medical procedures in old age). The mutation of health systems from - originally - social activities to business branches more and more gives priority to economical based decisions in medicine, but otherwise has advanced an increasing number of new health professions. The origin of the actual debate on euthanasia is the development and judicial certification of individual's self-determination in modern societies. However, euthanasia is still refused world-wide because it is considered to be linked with a process of weakening basic ethical principles. The 3 seemingly independent developments certainly are facts in modern societies. They hardly can be influenced by the medical profession, being forced to conform to them. However, there are significant connections between them.A geriatric health system, primarily denying individual demands and basic convictions of old people, contributes to an attitude of non-acceptance towards daily practice medicine. The same effect may result from the economic transformation of medicine when creating a system of self-perpetuating demand (being characteristic for an "ideal" business branch) by "unlimited" prolongation of life of the very old and highly disabled patients. The result from this development undoubtedly will be an increasing demand for self-determination at the end of life, including medical assistance in suicide and euthanasia, which cannot successfully be confronted with moral appeals.Alternatively, a basic correction of the geriatric health system must be introduced mainly including psychodynamic factors in medical decision making, or euthanasia will be accepted by the majority, as already has happened in the Netherlands. PMID:10506385

  19. Psychiatric emergencies in the geriatric population.

    PubMed

    Borja, Ben; Borja, Czarina Santos; Gade, Swami

    2007-05-01

    Failure to recognize psychiatric conditions in any age group particularly in the elderly could lead to a very complicated clinical picture and may lead to increased health expenditures. Psychiatric emergencies can be secondary to numerous factors: geriatric depression and suicide, behavioral disturbance secondary to underlying organic conditions, substance abuse, elder abuse, and medication-induced adverse events. This article discusses mainly geriatric depression, elder abuse, and conditions emanating from iatrogenic causes. PMID:17462524

  20. The Clinical Education of Medical Students: A Perspective from Internal Medicine.

    ERIC Educational Resources Information Center

    Tierney, Lawrence M., Jr.

    1986-01-01

    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)

  1. An international model for geriatrics program development in China: the Johns Hopkins-Peking Union Medical College experience.

    PubMed

    Leng, Sean X; Tian, Xinping; Liu, Xiaohong; Lazarus, Gerald; Bellantoni, Michele; Greenough, William; Fried, Linda P; Shen, Ti; Durso, Samuel C

    2010-07-01

    China has the world's largest and most rapidly growing older adult population. Recent dramatic socioeconomic changes, including a large number of migrating workers leaving their elderly parents and grandparents behind and the 4:2:1 family structure caused by the one-child policy, have greatly compromised the traditional Chinese family support for older adults. These demographic and socioeconomic factors, the improved living standards, and the quest for higher quality of life are creating human economic pressures. The plight of senior citizens is leading to an unprecedented need for geriatrics expertise in China. To begin to address this need, the Johns Hopkins University School of Medicine (JHU) and Peking Union Medical College (PUMC) have developed a joint international project aimed at establishing a leadership program at the PUMC Hospital that will promote quality geriatrics care, education, and aging research for China. Important components of this initiative include geriatrics competency training for PUMC physicians and nurses in the Division of Geriatric Medicine and Gerontology at JHU, establishing a geriatrics demonstration ward at the PUMC Hospital, faculty exchange between JHU and PUMC, and on-site consultation by JHU geriatrics faculty. This article describes the context and history of this ongoing collaboration and important components, progress, challenges, and future prospects, focusing on the JHU experience. Specific and practical recommendations are made for those who plan such international joint ventures. With such unique experiences, it is hoped that this will serve as a useful model for international geriatrics program development for colleagues in the United States and abroad. PMID:20533962

  2. From Aging...to Saging--The Ohio State Senior Partners Program: Longitudinal and Experiential Geriatrics Education

    ERIC Educational Resources Information Center

    Kantor, Bonnie S.; Myers, Michelle R.

    2006-01-01

    The Ohio State College of Medicine began its Senior Partners Program (SPP) in 2001 as part of its commitment to integrate geriatric education throughout all four years of the medical curriculum. For participating senior partners and medical students, the SPP has signified a journey through a continuum of aging. Initial evaluations suggest that…

  3. Academic Performance in the Context of a "Three Excused Absences" Psychiatry Clerkship Policy

    ERIC Educational Resources Information Center

    Schillerstrom, Jason E.; Lutz, Mary

    2013-01-01

    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…

  4. 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

    2012-01-01

    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…

  5. Subspecialty Exposure in a Psychiatry Clerkship Does Not Improve Student Performance in the Subject Examination

    ERIC Educational Resources Information Center

    Retamero, Carolina; Ramchandani, Dilip

    2013-01-01

    Objective: The authors compared the NBME subject examination scores and subspecialty profiles of 3rd-year medical students who were assigned to psychiatry subspecialties during their clerkship with those who were not. Method: The authors collated and analyzed the shelf examination scores, the clinical grades, and the child psychiatry and emergency…

  6. 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

    2012-01-01

    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…

  7. Creation of a Web-Based Lecture Series for Psychiatry Clerkship Students: Initial Findings

    ERIC Educational Resources Information Center

    Martin, Vicki L.; Bennett, David S.

    2004-01-01

    Objective: In recent years, the trend in medical education has been to utilize clerkship settings outside the medical school. Subsequently, students rotate at distant sites from the main campus and have lectures of varying quantity and quality. The objective of the present study was to standardize the core didactic experience for students in the…

  8. The Performance of Female Medical Students in an Obstetrics and Gynecology Clerkship.

    ERIC Educational Resources Information Center

    Miller, Joseph M.; Smith, Imogene K.

    1982-01-01

    A study showed that although female medical students had slightly lower National Board examination scores on part one and lower grade point averages, they performed significantly better in the obstetrics and gynecology clerkship. Possible factors include women students' interest in women's health care and female representation on the house staff.…

  9. Influence of Clerkship on Attitudes of Medical Students toward Psychiatry across Cultures: United States and Qatar

    ERIC Educational Resources Information Center

    Burgut, F. Tuna; Polan, H. Jonathan

    2013-01-01

    Objective: To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries. Methods: A…

  10. Development of a longitudinal integrated clerkship at an academic medical center

    PubMed Central

    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

    2011-01-01

    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

  11. The Integration of Psychomotor Skills in a Hybrid-PBL Dental Curriculum: The Clinical Clerkships.

    ERIC Educational Resources Information Center

    Walton, Joanne N.; MacNeil, M. A. J.; Harrison, Rosamund L.; Clark, D. Christopher

    1998-01-01

    Describes the restructuring of clinical clerkships at the University of British Columbia (Canada) dental school as part of a new, hybrid, problem-based learning (PBL) curriculum, focusing on strategies for integrating development of psychomotor skills. Methods of achieving both horizontal and vertical integration of competencies through grouping…

  12. Medical Student Psychiatry Examination Performance at VA and Non-VA Clerkship Sites

    ERIC Educational Resources Information Center

    Tucker, Phebe; von Schlageter, Margo Shultes; Park, EunMi; Rosenberg, Emily; Benjamin, Ashley B.; Nawar, Ola

    2009-01-01

    Objective: The authors examined the effects of medical student assignment to U.S. Department of Veterans Affairs (VA) Medical Center inpatient and outpatient psychiatry clerkship sites versus other university and community sites on the performance outcome measure of National Board of Medical Examiners (NBME) subject examination scores. Methods:…

  13. 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

    2014-01-01

    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…

  14. Medical Student Clinics: The Basis for a Clerkship in Family Practice.

    ERIC Educational Resources Information Center

    Dervin, John V.; Rodnick, Jonathan E.

    1979-01-01

    The key element in a clerkship in family practice at Community Hospital, Santa Rosa, California, is the student's General Medical Clinic. Under the supervision of a family physician teacher, senior medical students work as a team with family nurse practitioners caring for patients. (Author/JMD)

  15. Peer Evaluation in a Clinical Clerkship: Students' Attitudes, Experiences, and Correlations with Traditional Assessments

    ERIC Educational Resources Information Center

    Levine, Ruth E.; Kelly, P. Adam; Karakoc, Tayfun; Haidet, Paul

    2007-01-01

    Objective: The authors performed this study to determine whether clerkship peer evaluations, initiated as part of our "team-based learning" curriculum in 2002, correlated with other student performance measures, and to determine what qualities students rate in their peer evaluations. Method: The authors correlated peer evaluation scores with other…

  16. 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

    2012-01-01

    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

  17. Do Clinical Evaluations in a Psychiatry Clerkship Favor Students with Positive Personality Characteristics?

    ERIC Educational Resources Information Center

    Chibnall, John T.; Blaskiewicz, Robert J.

    2008-01-01

    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…

  18. A Pilot Survey of Patient-Initiated Assaults on Medical Students during Clinical Clerkship

    ERIC Educational Resources Information Center

    Waddell, Andrea E.; Katz, Mark R.; Lofchy, Jodi; Bradley, John

    2005-01-01

    Objectives: To assess the incidents of patient-initiated assault (PIA) against clinical clerks during the first six months of clinical clerkship. To characterise the assaults with respect to service, location, clerk gender, patient gender. To examine the students' perceptions of the reporting process for PIA. Methods: A brief email survey was sent…

  19. 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

    2011-01-01

    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'…

  20. 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

    2014-01-01

    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

  1. 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

    2011-01-01

    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'

  2. 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

    2014-01-01

    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…

  3. Evaluation of geriatric changes in dogs

    PubMed Central

    Pati, Soumyaranjan; Panda, S. K.; Acharya, A. P.; Senapati, S.; Behera, M.; Behera, S. S.

    2015-01-01

    Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart of different breeds was followed. The external characteristics such as hair coat texture, dental wear and tear, skin texture and glaucoma were taken as a marker of old age. Haematology, serum biochemistry and urine analysis were also included in the study. Results: External visible changes like greying of hair, dull appearance of hair coat, glaucoma, osteoarthritis, dental wear and tear were commonly encountered in the aged dogs. The haemoglobin, total erythrocyte count and packed cell volume showed a decreasing trend in the geriatric groups. Biochemical values like total protein, albumin, calcium level showed a decreasing trend while urea level with an increasing trend in geriatric dogs without any much alteration in serum glutamic-oxaloacetic transaminse, serum glutamic-pyruvate transaminase, cholesterol and creatinine. Physical examination of urine revealed yellow, amber, red, deep red color with turbidity and higher specific gravity. Chemical examination revealed presence of protein, glucose, ketone bodies, blood and bilirubin on some cases. The culture and sensitivity test of the urine samples revealed presence of bacteria with sensitive and resistance to some antibiotics. Conclusion: External visible changes are still the golden standard of determining the old age in dogs. Haemato-biochemical evaluation can be useful for correlating with the pathophysiological status of the animal. Biochemical analysis of urine can be employed rightly as kidney dysfunction is being major geriatric problem. Anaemia, jaundice, nephritis, hepatitis are the most common findings considered during old age. PMID:27047084

  4. Geriatric rehabilitation. 4. Assessment, preservation, and enhancement of fitness and function.

    PubMed

    Means, K M; Currie, D M; Gershkoff, A M

    1993-05-01

    This self-directed learning module highlights the assessment, preservation, and enhancement of fitness and function in the older adult. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on functional assessment, deconditioning, exercise testing and physiology, gait disorders and falls, sports injuries, and industrial injuries in the older adult. PMID:8489374

  5. Development and validation of a questionnaire for evaluation of students' attitudes towards family medicine.

    PubMed

    ter, Marija Petek; vab, Igor; Klemenc-Keti, Zalika; Kersnik, Janko

    2015-03-01

    The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students' attitudes towards family medicine and to evaluate the impact of the clerkship on students' attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 final-year students in academic year 2007/08. The third phase consisted of development of a final tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students' attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students' attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students' attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the first attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students' attitudes in undergraduate curricula and for prediction of students' preferences regarding their future professional career in family medicine. PMID:26040061

  6. Impact of clerkship attachments on students’ attitude toward pharmaceutical care in Ethiopia

    PubMed Central

    Tsega, Bayew; Bhagavathula, Akshaya Srikanth; Sarkar, Barun Ranjan; Melaku, Tadesse; Shewamene, Zewdneh

    2015-01-01

    Objective The study objective is to investigate the impact of mandatory clinical clerkship courses on 5th-year pharmacy students’ attitudes and perceived barriers toward providing pharmaceutical care (PC). Methods A cross-sectional survey was conducted among 5th-year pharmacy students undertaking mandatory clinical clerkship in the University of Gondar, Ethiopia. A pharmaceutical care attitudes survey (PCAS) questionnaire was used to assess the attitude (14 items), commonly identified drug-related problem/s (1 item) during clerkships, and perceived barriers (12 items) toward the provision of PC. Statistical analysis was conducted on the retrieved data. Results Out of the total of 69 clerkship students, 65 participated and completed the survey (94.2% response rate). Overall, 74.45% of participants opinioned a positive attitude toward PC provision. Almost all respondents agreed that the primary responsibility of pharmacists in the healthcare setting was to prevent and solve medication-related problems (98.5%), practice of PC was valuable (89.3%), and the PC movement will improve patient health (95.4%), respectively. Unnecessary drug therapy (43%), drug–drug interactions (33%), and non-adherence to medications (33%) were the most common drug-related problems identified in wards. Highly perceived barriers for PC provision included lack of a workplace for counseling in the pharmacy (75.4%), a poor image of pharmacist’s role in wards (67.7%), and inadequate technology in the pharmacy (64.6%). Lack of access to a patient’s medical record in the pharmacy had significant association (P<0.05) with PC practice, performance of PC during clerkship, provision of PC as clinical pharmacists, and Ethiopian pharmacists benefiting by PC. Conclusion Ethiopian clinical pharmacy students have a good attitude toward PC. Efforts should be targeted toward reducing these drug therapy issues, and aiding the integration of PC provision with pharmacy practice. PMID:26056513

  7. Chemotherapy in the geriatric population.

    PubMed

    Green, Jaime M; Hacker, Eileen Danaher

    2004-12-01

    The population in America is aging, and the number of older adults who develop cancer continues to grow. Gerontologic considerations in the delivery of health care become increasingly more important as a result of these population trends. Factors such as physiologic age-related changes, comorbid conditions, and the incidence of polypharmacy contribute to the challenges of administering chemotherapy to older patients with cancer. Age-related physiologic changes, including alterations in the gastrointestinal system, renal system, body composition, and hematopoiesis, impact patients' ability to tolerate standard doses of chemotherapy. In addition, these changes increase the likelihood of developing severe toxicities. Comorbid conditions confound the side effects of chemotherapy, and the use of multiple medications places older patients with cancer at increased risk for developing drug interactions. Older patients with cancer may be more susceptible to developing toxicities from chemotherapy, and these toxicities may be more severe. When healthcare professionals follow age-appropriate standards of oncology care, chemotherapy can be safely and effectively administered to older patients with cancer. Oncology nurses play a crucial role in assessing for potential complications and managing toxicities. Incorporating geriatric care into oncology nurses' daily practice ensures quality care for older patients with cancer. PMID:15637954

  8. Advancing geriatrics research, education, and practice: policy challenges after the great recession.

    PubMed

    Zerzan, Judy T; Rich, Eugene C

    2014-06-01

    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

  9. Geriatric patient simulations for dental hygiene.

    PubMed

    Johnson, L A; Cunningham, M A; Finkelstein, M W; Hand, J S

    1997-08-01

    The rapidly increasing number of this country's elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics. PMID:9290591

  10. American Association for Geriatric Psychiatry

    MedlinePlus

    ... time and effort you put into the Scholars programming at the AAGP conference. I had a wonderful ... San Diego School of Medicine surveyed published, English-language, peer-reviewed reports of qualitative and quantitative studies ...

  11. When Patients Teach Their Doctors: A Curriculum for Geriatric Education

    ERIC Educational Resources Information Center

    Tomkowiak, John; Gunderson, Anne

    2004-01-01

    In response to aging patient demographics and a call for increased formal geriatric training in medical schools, a community volunteer geriatric mentor program, Bridging Generations, was developed to shape attitudes of medical students caring for the elderly. The geriatric mentor experience provided students with unique insight into the challenges…

  12. Geriatrics Educational Outreach: A Tale of Three GRECCs

    ERIC Educational Resources Information Center

    Clark, Elizabeth; Fitzgerald, James T.; Griffith, Jennifer; Weir, Charlene

    2011-01-01

    Current geriatrics workforce projections indicate that clinicians who care for adults will need basic geriatrics knowledge and skills to address the geriatric syndromes and issues that limit functional independence and complicate medical management. This is most evident for the clinicians caring for veterans in the Department of Veterans Affairs…

  13. [Geriatric Pharmacotherapy in Urology: An Introduction from a Geriatric Pharmacist's Perspective].

    PubMed

    Hanke, F; Plum, M; Wiedemann, A

    2016-02-01

    In Germany, too, adverse drug events (ADEs) have been identified as a central problem in the care of geriatric patients. Especially in elderly patients with multimorbidity and increasing frailty, ADEs are among the most frequent and cost-intensive causes of illness in healthcare. In most cases, they are due to drug-related diseases, which necessitate enhanced risk awareness and improved cooperation between physicians, medical specialists, geriatric nurses and pharmacists. In this context, the use of urologic medication for geriatric patients requires particular attention by the consultant. PMID:27008337

  14. Palliative Care for the Geriatric Anesthesiologist.

    PubMed

    Gustin, Allen N; Aslakson, Rebecca A

    2015-09-01

    Many seriously ill geriatric patients are at higher risk for perioperative morbidity and mortality, and incorporating proactive palliative care principles may be appropriate. Advanced care planning is a hallmark of palliative care in that it facilitates alignment of the goals of care between the patient and the health care team. When these goals conflict, perioperative dilemmas can occur. Anesthesiologists must overcome many cultural and religious barriers when managing the care of these patients. Palliative care is gaining ground in several perioperative populations where integration with certain patient groups has occurred. Geriatric anesthesiologists must be aware of how palliative care and hospice influence and enhance the care of elderly patients. PMID:26315640

  15. A brief history and lessons learned from twin efforts to transform medicine.

    PubMed

    Hayley, Déon Cox; Sachs, Greg A

    2005-02-01

    In this article, we consider the intersection between the fields of geriatrics and palliative medicine in the United States. Although geriatrics and palliative medicine have sometimes used different strategies to address the same challenges, they have created opportunities where both fields can learn from the experiences of the other. One specialty may be able to learn from issues already dealt with by the other. Because the fields of geriatrics and palliative medicine have so much in common, including health professionals who bridge the two fields, it is the authors' goal to foster greater understanding and collaboration between the specialties and thus strengthen both. PMID:15639034

  16. Research Priorities for High Quality Geriatric Emergency Care: Medication Management, Screening and Prevention and Functional Assessment

    PubMed Central

    Carpenter, Christopher R.; Heard, Kennon; Wilber, Scott; Ginde, Adit A.; Stiffler, Kirk; Gerson, Lowell W.; Wenger, Neal S.; Miller, Douglas K.

    2011-01-01

    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

  17. Geriatric Education in the Health Professions: Are We Making Progress?

    PubMed Central

    Bardach, Shoshana H.; Rowles, Graham D.

    2012-01-01

    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

  18. Motivation underlying career choice for internal medicine and surgery.

    PubMed

    Williams, G C; Saizow, R; Ross, L; Deci, E L

    1997-12-01

    Self-determination theory (Deci and Ryan, 1985) was used to predict medical students' career choices for internal medicine or surgery based on their experiences of the autonomy support provided by the instructors in the two corresponding third-year clerkships. Fourth-year medical students (n = 210) at three medical schools completed questionnaires that assessed (1) retrospective prior likelihood (as of the end of second year) of their going into internal medicine and surgery, (2) their perceived competence with respect to these two medical specialties, (3) their interest in the problems treated in each specialty, (4) the autonomy support of the instructors on the two corresponding rotations, (5) the current likelihood (late in the fourth year) of going into each of the two specialties, and (6) their actual residency choices. For a subset (n = 64), actual prior likelihoods of going into the two careers had also been assessed at the end of their second year. Structural equation modeling confirmed, as hypothesized, (a) that perceived autonomy support of the corresponding clerkship would predict students' choices of internal medicine or surgery, even after the effects of retrospective (and actual) prior likelihood had been removed, and (b) that this relationship between perceived autonomy support and career choice was mediated by perceived competence and interest. The present study suggests that students' experiences on clerkships do affect the likelihood that they will select particular specialties, and that students' interest in the areas are good indicators of the selections they will make. PMID:9428089

  19. Geriatric Syndromes: Clinical, Research and Policy Implications of a Core Geriatric Concept

    PubMed Central

    Inouye, Sharon K.; Studenski, Stephanie; Tinetti, Mary E.; Kuchel, George A.

    2008-01-01

    Geriatricians have embraced the term “geriatric syndrome”, using it extensively to highlight the unique features of common health conditions in the elderly. Geriatric syndromes, such as delirium, falls, incontinence and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining geriatric syndromes, and proposes a balanced approach of developing preliminary criteria based on peer-reviewed evidence. Based on a review of the literature, four shared risk factors—older age, baseline cognitive impairment, baseline functional impairment, and impaired mobility—were identified across five common geriatric syndromes (pressure ulcers, incontinence, falls, functional decline, and delirium). Understanding basic mechanisms involved in geriatric syndromes will be critical to advancing research and developing targeted therapeutic options. However, given the complexity of these multifactorial conditions, attempts to define relevant mechanisms will need to incorporate more complex models, including a focus on synergistic interactions between different risk factors. Finally, major barriers have been identified in translating research advances, such as preventive strategies of proven effectiveness for delirium and falls, into clinical practice and policy initiatives. National strategic initiatives are required to overcome barriers and to achieve clinical, research, and policy advances that will improve quality of life for older persons. PMID:17493201

  20. Geriatric Oncology Research to Improve Clinical Care

    PubMed Central

    Mohile, Supriya; Dale, William; Hurria, Arti

    2013-01-01

    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

  1. Geriatric dentistry--meet the need.

    PubMed

    Issrani, Rakhi; Ammanagi, Renuka; Keluskar, Vaishali

    2012-06-01

    Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an inter-disciplinary team with other health care professionals. Geriatric health is an ignored and under-explored area worldwide. Oral health reflects overall well being for the elderly population. Conversely, elderly patients are more predisposed to oral conditions due to age-related systemic diseases and functional changes. The major barriers to practising geriatric dentistry are the lack of trained faculty members, a crowded curriculum and monetary concerns. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the elderly. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, dental professionals must have a proper understanding of the magnitude of the services to be provided to the elderly. This could only be realised through an education programme in geriatric dentistry, which should be started without further delay. This article hence sets out the objectives, needs, present scenario, strategies and types of dental treatment required by the elderly population. PMID:22612827

  2. Directory of Curriculum Guidelines for Geriatric Education.

    ERIC Educational Resources Information Center

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Health Professions.

    This directory contains information on the nature and availability of curriculum guidelines for education and training programs in geriatrics and gerontology. The curriculum guidelines or model curricula were prepared by professional associations or with federal support, most notably through the Administration on Aging or the Health Resources and…

  3. [The particular characteristics of caregivers in geriatrics].

    PubMed

    Viana, Nicola

    2012-01-01

    The perception of the work of a caregiver in geriatrics is often inaccurate. Considered to consist of the most unrewarding tasks, the role of caregivers in supporting residents and families is however essential, both in terms of day-today care as well as for the prevention of dependency. PMID:22741315

  4. Faculty Preparedness in Geriatric Optometry Education.

    ERIC Educational Resources Information Center

    Mancil, Gary L.; And Others

    1995-01-01

    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…

  5. A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

    PubMed Central

    Daud-Gallotti, Renata Mahfuz; Morinaga, Christian Valle; Arlindo-Rodrigues, Marcelo; Velasco, Irineu Tadeu; Arruda Martins, Milton; Tiberio, Iolanda Calvo

    2011-01-01

    INTRODUCTION: Patient safety is seldom assessed using objective evaluations during undergraduate medical education. OBJECTIVE: To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure. METHODS: In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated. RESULTS: A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59±1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54) offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains. CONCLUSIONS: An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical student clerkship. PMID:21876976

  6. What’s Behind a Name: The Kaufman Prize of the Canadian Geriatrics Society

    PubMed Central

    Hogan, David B.

    2011-01-01

    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

  7. Natural Products and Supplements for Geriatric Depression and Cognitive Disorders: An Evaluation of the Research

    PubMed Central

    Varteresian, Taya; Lavretsky, Helen

    2014-01-01

    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

  8. Can enriching emotional intelligence improve medical students’ proactivity and adaptability during OB/GYN clerkships?

    PubMed Central

    Guseh, Stephanie H.; Chen, Xiaodong P.

    2015-01-01

    Objectives The purpose of this pilot study was to examine our hypothesis that enriching workplace emotional intelligence through resident coaches could improve third-year medical students’ adaptability and proactivity on the Obstetrics and Gynecology clerkship. Methods An observational pilot study was conducted in a teaching hospital. Fourteen 3rd year medical students from two cohorts of clerkships were randomly divided into two groups, and equally assigned to trained resident coaches and untrained resident coaches. Data was collected through onsite naturalistic observation of students’ adaptability and proactivity in clinical settings using a checklist with a 4-point Likert scale (1=poor to 4=excellent). Wilcoxon rank-sum test was used to compare the differences between these two groups. Results A total of 280 data points were collected through onsite observations conducted by investigators. All (n=14) students’ adaptability and proactivity performance significantly improved from an average of 3.04 to 3.45 (p=0.014) over 6-week clerkship. Overall, students with trained resident coaches adapted significantly faster and were more proactive in the obstetrics and gynecology clinical setting than the students with untrained coaches (3.31 vs. 3.24, p=0.019). Conclusions Findings from our pilot study supported our hypothesis that enriching workplace emotional intelligence knowledge through resident coaches was able to help medical students adapt into obstetrics and gynecology clinical settings faster and become more proactive in learning. Clerkship programs can incorporate the concept of a resident coach in their curriculum to help bridge medical students into clinical settings and to help them engage in self-directed learning throughout the rotation. PMID:26708233

  9. Medical student quality-of-life in the clerkships: a scale validation study.

    PubMed

    Brannick, Michael T; Horn, Gregory T; Schnaus, Michael J; Wahi, Monika M; Goldin, Steven B

    2015-04-01

    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

  10. What difficulties do faculty members face when conducting workplace-based assessments in undergraduate clerkships?

    PubMed Central

    Mak-van der Vossen, Marianne C.; Croiset, Gerda; Kusurkar, Rashmi A.

    2016-01-01

    Objectives Workplace-based assessments are based on the principle of providing feedback to medical students on clinical performance in authentic settings. In practice, however, the assessment often overshadows the feedback. The aim of this study was to determine what problems faculty perceived when performing workplace-based assessments and what solutions they suggested to overcome these difficulties. Methods Discussion meetings were conducted with education coordinators and faculty (n=55) from 11 peripheral hospitals concerning the difficulties encountered when conducting workplace-based assessments. We analysed the reports from these discussion meetings using an integrated approach guided by our research questions to code the data. Two researchers analysed the data independently and resolved differences of opinion through consensus. Results The problems perceived by faculty in workplace-based assessments (difficulties) and suggestions for improvement formed the overarching themes. Problems included the short duration of clerkships, students choosing the assessment moments, the use of grades for the mini-Clinical Evaluation Exercise, the difficulty in combining teacher and assessor roles and the difficulty in giving fail judgements. Suggestions for improvement included longer clerkship duration, faculty choosing the assessment moments, using a pass/fail system for the mini-Clinical Evaluation Exercise and forward feeding of performance from earlier clerkships following a fail judgement. Conclusions Our study indicates that faculty perceive difficulties when conducting workplace-based assessments. These assessments need periodical review to understand the difficulties faculty experience using them; they also require periodical feedback to ensure their proper and effective use. PMID:26803256

  11. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship.

    PubMed

    Konkin, Jill; Suddards, Carol

    2012-10-01

    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 ethic of caring is a moral framework for caring. This study explored the development of an ethic of caring in an LIC using empathy, compassion and taking responsibility as descriptors of caring. Through a hermeneutic phenomenological study, the authors focused on students' accounts of being with patients. Following an iterative process of successive analyses and explorations of the relevant literature, sensitizing concepts related to physician identity, and an ethic of caring were used to make sense of these accounts following the principles of constructivist grounded theory methodology. Continuity afforded by the LIC results in a safe environment in which students can meaningfully engage with patients and take responsibility for their care under the supervision of a physician teacher. Together these attributes foster an emerging physician identity born at the site of patient-student interaction and grounded in an ethic of caring. A medical student's evolving professional identity in the clerkship includes the emergence of an ethic of caring. Student accounts of being with patients demonstrate that the LIC at the University of Alberta affords opportunities for students be receptive to and responsible for their patients. This ethic of caring is part of an emerging physician identity for the study participants. PMID:22052211

  12. [Development of a portfolio for competency-based assessment in a clinical clerkship curriculum].

    PubMed

    Roh, HyeRin; Lee, Jong-Tae; Yoon, Yoo Sang; Rhee, Byoung Doo

    2015-12-01

    The purpose of this report was to describe our experience in planning and developing a portfolio for a clinical clerkship curriculum. We have developed a portfolio for assessing student competency since 2007. During an annual workshop on clinical clerkship curricula, clerkship directors from five Paik hospitals of Inje University met to improve the assessment of the portfolio. We generated templates for students to record their activities and reflection and receive feedback. We uploaded these templates to our school's website for students to download freely. Annually, we have held a faculty development seminar and a workshop for portfolio assessment and feedback. Also, we established an orientation program on how to construct a learning portfolio for students. Future actions include creating a ubiquitous portfolio system, extending the portfolio to the entire curriculum, setting up an advisor system, and managing the quality of the portfolio. This study could be helpful for medical schools that plan to improve their portfolio assessment with an outcome-based approach. PMID:26657554

  13. [Effect of the active adult learning/patient oriented clerkship on affective reaction of students ∼ from the results of student survey].

    PubMed

    Saito, Isao; Kogo, Mari; Kobayashi, Aya; Watanabe, Toru; Abe, Seiji; Fuke, Shunya; Wakabayashi, Hitomi; Miyano, Masahiro; Karasawa, Koji; Ohto, Yuji; Okazaki, Keinosuke; Hoshi, Akane; Ohtaki, Yumi; Heito, Akira; Tanaka, Hiroki; Fujiwara, Hisato; Yagi, Hitoshi; Ichikura, Daisuke; Ishii, Ayako; Yamada, Kyohei; Sugisawa, Satoshi; Kato, Yukihisa; Murayama, Jun-Ichiro

    2011-01-01

    We have previously reported the efficacy of the Patient Oriented Clerkship (POC) in the clinical clerkship in Showa University Hospitals, by a trial with old four-year pharmacy program students. In the unique clerkship, each student has a patient in charge, and follows his/her clinical conditions throughout the rotation. The aim of the POC is that having the students learn spontaneously (Active Learning) and actively (Adult Learning) promoted by student's commitment and responsibility by communicating with patients and health professionals in a team. As the POC requires students both Active Learning and Adult Learning, we define the POC as Active Adult Learning (AAL). Having a patient in charge for each student gives them many opportunities to participate in the medical team and foster their problem solving skills. Our previous study eventually showed positive results of the POC in the one-month short clerkship in the four-year program. On the other hand, the effect of the unique hospital clerkship in the new six-year program is not known. We conducted a student survey to clarify the learning effect in the new six-year education system which was revised and 2.5 month clinical clerkship was scheduled according to the model core clerkship curriculum. This report is the first report to show a challenge of the AAL/POC clerkship in the new six-year pharmacy education program. PMID:22041698

  14. Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

    PubMed

    Bynum, Debra L; Wilson, Lindsay A; Ong, Thuan; Callahan, Kathryn E; Dalton, Thomas; Ohuabunwa, Ugochi

    2015-09-01

    In order to determine how often internal medicine and family medicine residents performed specific actions related to the geriatric competencies established by the American Geriatrics Society (AGS) when caring for older hospitalized adults, a cross-sectional anonymous survey of residents at the University of North Carolina, University of Washington, Wake Forest University, Duke University, and Emory University was undertaken. Data on frequency of self-reported behaviors were analyzed, with comparisons made for different levels of training, institution, and program. A total of 375 residents responded for an overall response rate of 48%. Residents reported that they often do not demonstrate all of the AGS recommended core competencies when caring for older adults in the hospital setting. Residents report more frequently performing activities that are routinely integrated into hospital systems such as reviewing medication lists, working with an interdisciplinary team, evaluating for inappropriate bladder catheters, and evaluating for pressure ulcers. There were no consistent differences between institutions and only minor differences noted between Family Medicine and Internal Medicine residents. Operationalizing core competencies by integrating them into hospital systems' quality process indicators may prompt more consistent high-quality care and ensure systems support residents' competence. PMID:26313811

  15. Training family medicine residents for assessment and advocacy of older adults.

    PubMed

    Robbins, Myral R

    2002-11-01

    A review of the Basic Standards for Residency Training in Osteopathic Family Practice and Manipulative Treatment by the American Osteopathic Association and the American College of Osteopathic Family Physicians revealed that the family medicine residency curriculum in place at Riverside Osteopathic Hospital in Trenton, Mich, lacked formal didactic and clinical teaching in geriatric medicine. Therefore, a geriatric curriculum focusing on functional assessment strategies was developed and implemented. A three-part, 6-hour educational series was delivered to family medicine residents, interns, and medical students at Riverside Osteopathic Hospital. Content for the sessions addressed a variety of assessment and screening tools; concepts of abuse, neglect, and guardianship; available community resources to support the independent functioning of older adults; and, application of knowledge and skills. The geriatric medicine series concluded with a working session to prepare an individualized management plan for each of the patients evaluated. Each family medicine resident, the target learners, demonstrated his skill at performing a functional assessment of a geriatric patient at the community-based Horizon Family Medical Center in Taylor, Mich. Peers and faculty provided feedback. Family medicine residents were able to transfer knowledge and skills from the classroom to a geriatric patient. This teaching curriculum is the starting point for further development of clinical and community-based geriatric experiences for the family medicine residents at Riverside Osteopathic Hospital. PMID:12462309

  16. Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized Study.

    PubMed

    Reyes, Juan A; Greenberg, Larrie; Amdur, Richard; Gehring, James; Lesky, Linda G

    2016-03-01

    Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241. PMID:26174046

  17. Effect of Handoff Skills Training for Students during the Medicine Clerkship: A Quasi-Randomized Study

    ERIC Educational Resources Information Center

    Reyes, Juan A.; Greenberg, Larrie; Amdur, Richard; Gehring, James; Lesky, Linda G.

    2016-01-01

    Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for…

  18. International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

    PubMed Central

    Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L.G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

    2014-01-01

    Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base. PMID:25071125

  19. 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…

  20. [Geriatric assessment prior to oncological therapy].

    PubMed

    Wedding, U

    2013-06-01

    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

  1. Using Facebook Within a Geriatric Pharmacotherapy Course

    PubMed Central

    2010-01-01

    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

  2. Postoperative Delirium in the Geriatric Patient.

    PubMed

    Schenning, Katie J; Deiner, Stacie G

    2015-09-01

    Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients older than 65 years receive greater than one-third of the more than 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. PMID:26315635

  3. Achieving High-Quality Multicultural Geriatric Care.

    PubMed

    2016-02-01

    As the ethnic diversity of the U.S. population increases, there is a growing awareness of healthcare disparities and the need to address them. This position statement that the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed outlines healthcare disparities in the United States and the minimum quality indicators that healthcare organizations and healthcare providers should adopt to ensure that all older adults receive care that is culturally appropriate and takes into account level of health literacy. PMID:26804356

  4. Redefining the Economics of Geriatric Orthopedics

    PubMed Central

    Nacca, Christopher; Paller, David; Daniels, Alan H

    2014-01-01

    Introduction: The heath care system in the United States is in the midst of a transition, in large part to help accommodate an older and more medically complex population. Central to the current evolution is the reassessment of value based on the cost utility of a particular procedure compared to alternatives. The existing contribution of geriatric orthopedics to the societal burden of disease is substantial, and literature focusing on the economic value of treating elderly populations with musculoskeletal injuries is growing. Materials and Methods: A literature review of peer-reviewed publications and abstracts related to the cost-effectiveness of treating geriatric patients with orthopedic injuries was carried out. Results: In our review, we demonstrate that while cost-utility studies generally demonstrate net society savings for most orthopedic procedures, geriatric populations often contribute to negative net society savings due to decreased working years and lower salaries while in the workforce. However, the incremental cost-effective ratio for operative intervention has been shown to be below the financial willingness to treat threshold for common procedures including joint replacement surgery of the knee (ICER US$8551), hip (ICER US$17 115), and shoulder (CE US$957) as well as for spinal procedures and repair of torn rotator cuffs (ICER US$12 024). We also discuss the current trends directed toward improving institutional value and highlight important complementary next steps to help overcome the growing demands of an older, more active society. Conclusion: The geriatric population places a significant burden on the health care system. However, studies have shown that treating this demographic for orthopedic-related injuries is cost effective and profitable for providers under certain scenarios. PMID:26246943

  5. Hemangiosarcoma in a geriatric Labrador retriever.

    PubMed

    Sharma, Diya

    2012-08-01

    A geriatric Labrador retriever dog was presented for acute collapse. The dog was conscious but lethargic, tachypneic, tachycardic with weak femoral pulses, occasional pulse deficits, and pale mucous membranes. Radiography, ultrasonography, quick assessment tests, and a complete blood (cell) count (CBC)/biochemistry panel indicated internal hemorrhage and potential problems with hemostasis. The dog was euthanized. A necropsy, histopathology, and immunohistochemistry for CD31 and Factor VIII-related antigen cell markers supported a diagnosis of splenic hemangiosarcoma. PMID:23372199

  6. Integrating geriatric resources into the classroom: a virtual tour example.

    PubMed

    Bonnel, Wanda; Fletcher, Kathy; Wingate, Anita

    2007-01-01

    As the older adult population increases, nursing students at all levels need geriatric content and access to geriatric resources. The Virtual Tour (VT) assignment, a combination of Web-based geriatric resources and applied learning activities, provides a simple way to integrate Web-based resources into classroom learning. VTs provide students a guide or "road map" to practical Web-based resources for client care. Evaluation data support that students like VTs and gain useful information for practice. VTs provide an easy way to expand geriatric resources available to students and to complement classroom content. PMID:17923286

  7. Early exposure to geriatric nursing through an externship program.

    PubMed

    Souder, Elaine; Beverly, Claudia J; Kitch, Stephanie; Lubin, Sandie A

    2012-01-01

    The Summer Geriatric Extern Program was developed in 2004 to provide nursing students between the junior and senior year an opportunity to learn more about careers in geriatric nursing.This full-time, eight-week commitment provides students with a stipend and a faculty mentor in their area of interest. Of the 24 externs since the inception of the program, seven have enrolled in graduate programs. The findings suggest that the summer geriatric externship program is effective in developing interest in a geriatric nursing career and providing exposure to nursing research and other aspects of the faculty role. PMID:22860479

  8. Non-healing wounds: the geriatric approach.

    PubMed

    Jaul, Efraim

    2009-01-01

    The most common types of non-healing wounds are four types: pressure ulcers, diabetic ulcers, ischemic ulcers and venous ulcers. Many of those wounds develop among the elderly, becoming non-healing to the extent that the patient may live with them all of his life, or even die because of them. Not enough attention is paid to the underlying contributing problems specific to the elderly patient. Those factors are physiologic (aging skin, immune state and atherosclerosis) and pathologic situation (diabetic disease, ischemia of leg). Therefore, the geriatric approach to a non-healing wound is comprehensive and multidisciplinary. Those including: patient's co-morbidities, functional state as measured by the activities of daily living (ADL) scale, nutritional status, social support, ethical beliefs and quality of life and not only the wound itself. Each discipline (the nursing staff, physician, dietitian, occupational, physical therapists and social worker) has its own task in preventing and treating such wounds. The ultimate goal therefore has been altered from healing of the wounds to symptom control, prevention of complications and to contribute to the patient's overall wellbeing. This review discusses all those items in a geriatric point of view, and how to deal with the non-healing wounds as a geriatric syndrome. PMID:18838182

  9. Optimization of Geriatric Pharmacotherapy: Role of Multifaceted Cooperation in the Hospital Setting.

    PubMed

    Petrovic, Mirko; Somers, Annemie; Onder, Graziano

    2016-03-01

    Because older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate pharmacotherapy in these patients. This narrative review describes approaches to improve pharmacotherapy in older people in the hospital setting. Screening to identify older patients at risk of drug-related problems and adverse drug reactions (ADRs) is the first critical step within a multistep approach to geriatric pharmacotherapy. Two methods that have been developed are the GerontoNet ADR risk score and the Brighton Adverse Drug Reactions Risk (BADRI) model, which take into account a number of factors, the most important of which is the number of medicines. In order to reduce potentially inappropriate prescribing in older patients, different types of interventions exist, such as pharmacist-led medication reviews, educational interventions, computerized decision support systems, and comprehensive geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach, by combining different techniques. None of the existing interventions shows a clear beneficial effect on patients' health outcomes if applied in isolation; however, when these interventions are combined within the context of a multidisciplinary team, positive effects on patients' health outcomes can be expected. Appropriate geriatric pharmacotherapy, global assessment of patients' clinical and functional parameters, and integration of skills from different healthcare professionals are needed to address medical complexity of older adults. PMID:26884392

  10. Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

    PubMed Central

    Chandra, Anupam; Crane, Sarah J; Tung, Ericka E; Hanson, Gregory J; North, Frederick; Cha, Stephen S; Takahashi, Paul Y

    2015-01-01

    There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year. PMID:26029477

  11. Geriatric care boot cAMP: an interprofessional education program for healthcare professionals.

    PubMed

    Solberg, Lauren B; Solberg, Laurence M; Carter, Christy S

    2015-05-01

    In response to the need for interprofessional geriatrics education, a half-day geriatric care boot camp for healthcare professionals was held that covered core concepts in geriatric medicine: delirium and dementia, medication management, palliative care, ethics, and a general overview of older adults. Aspects of the curriculum focused on interprofessional education, and the attendees and presenters were healthcare professionals from a wide variety of fields. Primary objectives were to determine changes in knowledge of core concepts in geriatrics and level of comfort in caring for older adults. Secondary objectives assessed whether participants found the interprofessional approach beneficial and whether they used or shared this information with others in their professional activities. Participants completed pre- and postassessment surveys. Changes in participant understanding of each core concept were statistically significant, as was the change in comfort level of participants in caring for older adults. Furthermore, attendees found the multidisciplinary perspective of the boot camp beneficial. A 3-month follow-up survey assessed whether attendees applied and shared information learned in their own professional activities. Half of the respondents who reported sharing universally shared core concepts. Delirium and dementia information was most frequently shared. Information was most frequently shared with students, nurses, and patients' families. Attendees less frequently shared, or did not share, with physicians, physician assistants, social workers, physical and occupational therapists, nutritionists, and dentists. The healthcare professionals who may benefit greatly from future education programs are those with whom the boot camp information was least frequently shared; thus, they are appropriate targets for advertisements for future programs. PMID:25989566

  12. Spontaneous resorption of a diabetic cataract in a geriatric dog.

    PubMed

    Gonzalez-Alonso-Alegre, E; Rodriguez-Alvaro, A

    2005-08-01

    Spontaneous cataract resorption is described in a geriatric cocker spaniel with a four-month history of diabetes mellitus. Resorption progressed to such a degree that vision was restored in that eye and almost all the cataract material disappeared. This is not common in geriatric dogs despite having been described with relative frequency in young animals with hereditary cataracts. PMID:16119062

  13. Designing a Multi-Disciplinary Geriatrics Health Professional Mentoring Program

    ERIC Educational Resources Information Center

    Cotter, J. James; Coogle, Constance L.; Parham, Iris A.; Head, Colleen; Fulton, LaQuana; Watson, Kathleen; Curtis, Angela

    2004-01-01

    This paper describes a Geriatric Health Professionals Mentoring Program designed to address recruitment and retention of health professionals in geriatrics and gerontology. The training provided information on the mentoring process, negotiating mentoring agreements, and coaching mentees. The evaluative framework described examines: (a) the effects…

  14. 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.

    2009-01-01

    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…

  15. Ethnogeriatric Education: A Collaborative Project of Geriatric Education Centers

    ERIC Educational Resources Information Center

    Severance, Janet S.; Yeo, Gwen

    2006-01-01

    Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the…

  16. Geriatrics in Family Practice Residency Education: An Unmet Challenge.

    ERIC Educational Resources Information Center

    Gazewood, John D.; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

    2003-01-01

    Offers a position statement on geriatric education in family practice residency, asserting that limited progress has been made despite an increasing need for such education. Offers seven recommendations, such as: every family practice residency should integrate a variety of training sites into a comprehensive curriculum of geriatric education that

  17. An Ocular Prosthesis For A Geriatric Patient: A Case Report

    PubMed Central

    Kamble, Vikas B.; Kumar, Mukesh; Panigrahi, Debashis

    2013-01-01

    When geriatric patients with maxillofacial defects are handled, the clinician must be confident of addressing and managing the psychology of these patients. It is also required that the clinician must understand and be sensitive to the medical and financial states of geriatric patients. The loss of an eye has a far-reaching impact on an individual’s psychology and an immediate replacement is necessary to promote the physical and psychological healing of the patient and to improve his/her social acceptance. Special approaches and treatment goals are considered while treating geriatric patients with ocular defects and special consideration is given to the appointment length, the number of appointments and their medical and financial statuses. This article presents the prosthetic rehabilitation of a geriatric patient with an ocular defect, with a customized stock ocular prosthesis, by using a minimal intervention geriatric approach. PMID:23905149

  18. Assessing geriatrics in undergraduate medical education: two different approaches.

    PubMed

    Eleazer, G Paul; Liken, Michelle; Hirth, Victor A; Johnson, David; Lucas, Amy; Egbert, John; Boland, Rebecca H; Wieland, Darryl

    2004-01-01

    Most medical schools do not have a separate course in geriatrics, but rather incorporate geriatrics into existing courses. Tracking and assessing curriculum content is more difficult in this setting. This paper describes and compares two approaches to assess curriculum content in geriatrics: a survey of course directors and a course objectives review. The results suggest that course directors report more geriatric content when asked as part of a regular survey than they identify as specific course objectives. Course objectives may be more reflective of the actual emphasis placed on aging-related material in courses. These two approaches appear to be complementary. Medical educators may find both self-report and course objective analysis to be useful and complementary in tracking geriatric material in the undergraduate medical curriculum. PMID:15871933

  19. Intention of nursing students to work in geriatrics.

    PubMed

    Ben Natan, Merav; Danino, Sharon; Freundlich, Nelli; Barda, Ayelet; Yosef, Racheli Mor

    2015-01-01

    The current study examined factors related to nursing students' intention to work in geriatrics upon graduation. A cross-sectional, descriptive design was used. A random sample of 200 nursing students completed a questionnaire based on the Theory of Planned Behavior and Kogan's Attitudes Toward Old People Scale. Participants expressed low intention to work in geriatrics upon graduation. Results of a multiple linear regression indicated that students' attitudes toward working in geriatrics and normative and control beliefs were found to be predictors of this intention. Additionally, male and religious students were more inclined to work in geriatrics. The current study indicated that nursing students' attitudes toward working in geriatrics were significantly predictive of their intention to work in this field upon graduation. PMID:25707032

  20. Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.

    PubMed

    Chaïbi, Pascal; Magné, Nicolas; Breton, Sylvie; Chebib, Amale; Watson, Sarah; Duron, Jean-Jacques; Hannoun, Laurent; Lefranc, Jean-Pierre; Piette, François; Menegaux, Fabrice; Spano, Jean-Philippe

    2011-09-01

    Elderly patients represent a heterogeneous population in which decisions on cancer treatment are often difficult. The present study aims to report a 2-year period of the activity of geriatric assessment consultations and the impact on treatment decisions. Since January 2007, we have systematically carried out geriatric consultations, using well-known international scales, for elderly patients in whom treatment decisions appear complex to oncologists. From January 2007 to November 2008, 161 patients (57 men, 104 women; median age 82.4 years, range 73-97) were seen at geriatric consultations. Most of the patients (134/161) were undergoing first-line treatment and cancer was metastatic in 86 patients (53%). Geriatric assessment found severe comorbidities (grade 3 or 4 in CIRS-G scale) in 75 patients, dependence for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, malnutrition in 104 patients (65%) and depression in 39 patients. According to the oncologists' prior decisions, there were no changes in treatment decisions in only 29 patients. Cancer treatment was changed in 79 patients (49%), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom the final decision was delayed or who underwent less intensive therapy had significantly more frequent severe comorbidities (23/34, p<0.01) and dependence for at least one ADL (19/34, p<0.01). In this study, we have found that comprehensive geriatric evaluation did significantly influence treatment decisions in 82% of our older cancer patients. PMID:20888781

  1. The Use of the Internet in Geriatrics Education: Results of a National Survey of Medical Geriatrics Academic Programs

    ERIC Educational Resources Information Center

    Hajjar, Ihab M.; Ruiz, Jorge G.; Teasdale, Thomas A.; Mintzer, Michael J.

    2007-01-01

    In order to characterize use of the Internet in medical geriatrics education programs, 130 medical education programs in the U.S. that train medical students, interns, residents, fellows and practicing physicians were asked to complete a survey developed by the Consortium of E-Learning in Geriatrics Instruction (CELGI). Sixty-eight programs…

  2. Thyroid disorders in the geriatric veterinary patient.

    PubMed

    Scott-Moncrieff, J Catharine

    2012-07-01

    The effects of age, concurrent illness, and administered medications complicate diagnosis of thyroid dysfunction in geriatric patients. Interpretation of thyroid hormone testing should take these factors into account. The most common thyroid disorder in dogs is acquired hypothyroidism. Therapeutic monitoring should be utilized for monitoring treatment of canine hypothyroidism. The most common thyroid disorder in cats is benign hyperthyroidism. Diagnosis is most often complicated by the presence of concurrent illness. Treatment should be individualized based on individual case characteristics and presence of concurrent illness. Some older cats have a palpable goiter months to years before development of clinical signs of hyperthyroidism. PMID:22720810

  3. Abdominal Pain in the Geriatric Patient.

    PubMed

    Leuthauser, Amy; McVane, Benjamin

    2016-05-01

    Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain. PMID:27133249

  4. The Geriatric Population and Psychiatric Medication

    PubMed Central

    Varma, Sannidhya; Sareen, Himanshu; Trivedi, J.K.

    2010-01-01

    With improvement in medical services in the last few years, there has been a constant rise in the geriatric population throughout the world, more so in the developing countries. The elderly are highly prone to develop psychiatric disorders, probably because of age related changes in the brain, concomitant physical disorders, as well as increased stress in later life. Psychiatric disorders in this population may have a different presentation than in other groups and some of psychopathologies might be mistaken for normal age related changes by an unwary clinician. Therefore the need of the day is to train psychiatrists and physicians to better recognize and manage mental disorders in this age group. PMID:21327169

  5. Changes in Study Strategies of Medical Students between Basic Science Courses and Clerkships Are Associated with Performance

    ERIC Educational Resources Information Center

    Ensminger, David C.; Hoyt, Amy E.; Chandrasekhar, Arcot J.; McNulty, John A.

    2013-01-01

    We tested the hypothesis that medical students change their study strategies when transitioning from basic science courses to clerkships, and that their study practices are associated with performance scores. Factor scores for three approaches to studying (construction, rote, and review) generated from student (n = 150) responses to a…

  6. Grading Medical Students in a Psychiatry Clerkship: Correlation with the NBME Subject Examination Scores and Its Implications

    ERIC Educational Resources Information Center

    Ramchandani, Dilip

    2011-01-01

    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

  7. Grading Medical Students in a Psychiatry Clerkship: Correlation with the NBME Subject Examination Scores and Its Implications

    ERIC Educational Resources Information Center

    Ramchandani, Dilip

    2011-01-01

    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…

  8. What is empathy, and how can it be promoted during clinical clerkships?

    PubMed

    Benbassat, Jochanan; Baumal, Reuben

    2004-09-01

    The ability of medical students to empathize often declines as they progress through the curriculum. This suggests that there is a need to promote empathy toward patients during the clinical clerkships. In this article, the authors attempt to identify the patient interviewing style that facilitates empathy and some practice habits that interfere with it. The authors maintain that (1) empathy is a multistep process whereby the doctor's awareness of the patient's concerns produces a sequence of emotional engagement, compassion, and an urge to help the patient; and (2) the first step in this process--the detection of the patient's concerns--is a teachable skill. The authors suggest that this step is facilitated by (1) conducting a "patient-centered" interview, thereby creating an atmosphere that encourages patients to share their concerns, (2) enquiring further into these concerns, and (3) recording them in the section traditionally reserved for the patient's "chief complaint." Some practice habits may discourage patients from sharing their concerns, such as (1) writing up the history during patient interviewing, (2) focusing too early on the chief complaint, and (3) performing a complete system review. The authors conclude that sustaining empathy and promoting medical professionalism among medical students may necessitate a change in the prevailing interviewing style in all clinical teaching settings, and a relocation of a larger proportion of clinical clerkships from the hospital setting to primary care clinics and chronic care, home care, and hospice facilities, where students can establish a continuing relationship with patients. PMID:15326005

  9. Geriatrics in medical students’ curricula: questionnaire-based analysis

    PubMed Central

    2014-01-01

    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

  10. Use of the Geriatric Institutional Assessment Profile: an integrative review.

    PubMed

    Tavares, João Paulo de Almeida; da Silva, Alcione Leite

    2013-07-01

    The Geriatric Institutional Assessment Profile (GIAP) is a self-report survey, designed to assess a hospital's readiness to implement a geriatric program. Considering the importance of the GIAP in delivering high-quality geriatric care, it is appropriate and relevant to conduct an integrative review about its use for the improvement of knowledge in this area. The primary aim of this study was to undertake an integrative review of the strengths and weaknesses of the GIAP and its main implications for geriatric nursing care. This integrative review was inspired by Whittemore's method. A total of 15 articles met the criteria for review. Data analysis revealed three themes: (a) the GIAP quality metrics, (b) geriatric nursing care initiatives assessment, and (c) geriatric nursing practice environment assessment. This review revealed a high degree of specificity, conformity, appropriateness, and utility in the evaluation of nurses' perceptions of the geriatric care, and the GIAP was considered to be a crucial tool in the development and improvement of caring for hospitalized older adults. PMID:23469767

  11. [Why should Byzantium be considered as a cradle of clinical geriatrics?].

    PubMed

    Lapin, Alexander

    2008-01-01

    Generally, roots of today's medical ethics are thought to have sprouted from antiquity and from classical Hebraic consciousness, while the origin of hospital medicine and institutional nursing of the elderly was assumed in Middle Age and in modern times, respectively. But even between these two periods, notably in Byzantium (324-1453) there were many famous physicians working with surprising skills in many disciplines such as surgery and ophthalmology. The most important achievement of that time, however, was in public health care. Following the Christian ideal of philanthropy, numerous hospitals (nosokomeia), hospices (xenodocheia) and asylums for the elderly (gerokomeia) of a remarkable organisation and professionalism were founded in many cities of the Byzantine Empire. Concerning the elderly patients, interesting findings were obtained concerning ageing process (eschatogeria), geriatric symptoms, multimorbidity, marasm and typically occurring diseases. Interesting approaches were realized with regard to the nursing care, diet and recommended life style for the elderly. By the end of the Byzantium Empire in 1453 and due to the different cultural development in the West, which was sometimes marked by conflicts between church and science and by the regulations of medicine, the knowledge about the Byzantine health care was almost lost. It survived, however, only in hospitals of occidental monastic orders, which brought their experience from East-Mediterranean area. Their hospitals were than a base for modern health care and for geriatrics. PMID:18807237

  12. Creating a Geriatric-Focused Model of Care in Trauma With Geriatric Education.

    PubMed

    Bortz, Kai L

    2015-01-01

    The literature suggests that by 2050, about 40% of all trauma patients will be over age 65 years. We already exceeded this prediction at Lehigh Valley Health Network in 2013, with 46.6% of the Pennsylvania trauma registry qualifiers being age 65 or greater, and 17.7% age 85 and greater. Currently, only 8.8% of trauma centers incorporate Geriatric Resource Programs into trauma care. Our trauma team has incorporated geriatric education for nurses by incorporating an educational nursing program called Nurses Improving Care for Healthsystem Elders, to improve outcomes, reduce hospital complications, and reduce health care costs for this high-risk population. The older adult population is on the rise and trauma nurses must be provided the tools to care for this high-risk patient group. PMID:26574941

  13. Comprehensive geriatric assessment during emergency admission.

    PubMed

    James, Jo

    2016-02-26

    This is the first in a short series that presents case study examples of the use of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic assessment model, which is designed to determine a frail older person's medical and mental health status, as well as functional, social and environmental issues. When applied by nurses, it can enable individualised planning for older people's health, safety and wellbeing. This article presents the case of a patient who had been admitted to hospital as an emergency for a suspected exacerbation of chronic obstructive pulmonary disease and subsequently developed a severe episode of delirium. It explores how the use of CGA at the point of her admission would have provided the patient with a higher standard of care and may have prevented her delirium. PMID:26917186

  14. Is cardiac surgery now a geriatric specialty?

    PubMed

    Nashef, Samer A M

    2007-09-01

    Like all medical specialties that deal with degenerative disease, cardiac surgery is increasingly being offered to older patients. This is driven by longer life expectancy, an increase in the prevalence of degenerative cardiac lesions, a substantial improvement in cardiac surgical results and competition from interventional cardiology in younger patient groups. Although there is no agreed definition of "geriatric", decision-making and the conduct of surgery and postoperative care in the elderly all require some modification of strategy to ensure the best results. Excellent outcomes can now be achieved (albeit at greater financial cost) in the older population, and these results hold well in the long term. Current trends suggest that both the provision and range of cardiac surgical services for the elderly may increase further. Despite this, there is still evidence of reluctance in considering older patients for cardiac surgery. PMID:17767450

  15. Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.

    PubMed

    Geduldig, Emma T; Kellner, Charles H

    2016-04-01

    This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients. PMID:26909702

  16. Aging biology and geriatric clinical pharmacology.

    PubMed

    McLean, Allan J; Le Couteur, David G

    2004-06-01

    Population aging evokes doomsday economic and sociological prognostication, despite a minority of older people suffering significant dependency and the potential for advances in therapeutics of age-related disease and primary aging. Biological aging processes are linked mechanistically to altered drug handling, altered physiological reserve, and pharmacodynamic responses. Parenteral loading doses need only be adjusted for body weight as volumes of distribution are little changed, whereas oral loading doses in some cases may require reduction to account for age-related increases in bioavailability. Age-related reduction of hepatic blood flow and hepatocyte mass and primary aging changes in hepatic sinusoidal endothelium with effects on drug transfer and oxygen delivery reduce hepatic drug clearance. Primary renal aging is evident, although renal clearance reduction in older people is predominantly disease-related and is poorly estimated by standard methods. The geriatric dosing axiom, "start low and go slow" is based on pharmacokinetic considerations and concern for adverse drug reactions, not from clinical trial data. In the absence of generalizable dosage guidelines, individualization via effect titration is required. Altered pharmacodynamics are well documented in the cardiovascular system, with changes in the autonomic system, autacoid receptors, drug receptors, and endothelial function to modify baseline cardiovascular tone and responses to stimuli such as postural change and feeding. Adverse drug reactions and polypharmacy represent major linkages to avoidable morbidity and mortality. This, combined with a deficient therapeutic evidence base, suggests that extrapolation of risk-benefit ratios from younger adults to geriatric populations is not necessarily valid. Even so, therapeutic advances generally may convert healthy longevity from an asset of fortunate individuals into a general social benefit. PMID:15169926

  17. Humanities and Geriatric Education: a Strategy for Recruitment?

    PubMed Central

    Frank, Christopher; Martin, Ruth Elwood

    2015-01-01

    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

  18. Creating a Surgery Clerkship in a Changing Environment: Reality, Simulation, and the Rules of Engagement

    PubMed Central

    Evans, Leigh V.; Gusberg, Richard J.

    2012-01-01

    This review describes the current challenges associated with creating a successful surgical clerkship and the ways in which teacher-focused and curriculum-focused initiatives can address these challenges. The challenges are both systemic (reflected by changes in our health care system and training programs) and institutional (reflected by factors that affect curriculum design and faculty advancement). Particular attention is paid to residents as teachers, faculty as mentors, the educational impact of the operating room, and the role of simulation. Strategies for engaging students, residents, and faculty are explored. The premise and impact of a comprehensive simulation course on the clinical education of medical students is detailed. Emphasis is placed on the educational validity of accountability and engagement of both the teachers and the learners. PMID:22461753

  19. Creating a surgery clerkship in a changing environment: reality, simulation, and the rules of engagement.

    PubMed

    Evans, Leigh V; Gusberg, Richard J

    2012-03-01

    This review describes the current challenges associated with creating a successful surgical clerkship and the ways in which teacher-focused and curriculum-focused initiatives can address these challenges. The challenges are both systemic (reflected by changes in our health care system and training programs) and institutional (reflected by factors that affect curriculum design and faculty advancement). Particular attention is paid to residents as teachers, faculty as mentors, the educational impact of the operating room, and the role of simulation. Strategies for engaging students, residents, and faculty are explored. The premise and impact of a comprehensive simulation course on the clinical education of medical students is detailed. Emphasis is placed on the educational validity of accountability and engagement of both the teachers and the learners. PMID:22461753

  20. Overcoming Electronic Medical Record Challenges on the Obstetrics and Gynecology Clerkship.

    PubMed

    Buery-Joyner, Samantha D; Dalrymple, John L; Abbott, Jodi F; Craig, LaTasha B; Forstein, David A; Graziano, Scott C; Hampton, Brittany S; Hopkins, Laura; Page-Ramsey, Sarah M; Pradhan, Archana; Wolf, Abigail; Mckenzie, Margaret L

    2015-09-01

    This article, for the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, supplies educators with a review of best practices regarding incorporation of the electronic medical record (EMR) into undergraduate medical education. The unique circumstances of the obstetrics and gynecology clerkship require specific attention as it pertains to medical student use of the EMR. An outline of the regulatory requirements and authoritative body recommendations provides some guidance for implementation in the undergraduate medical education setting. A review of the basic framework for development of an EMR curriculum and examples of curricular innovations published in the literature offers solutions for obstacles that may be encountered by students and medical educators. PMID:26244540

  1. Geriatric Care as an Introductory Pharmacy Practice Experience

    PubMed Central

    Boyce, Eric; Patel, Rajul A.

    2011-01-01

    Objective. To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students’ skills related to consultant pharmacists’ roles and patient care responsibilities. Design. A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions. Assessment. After completing the IPPE, students’ geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students’ care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive. Conclusions. This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students’ abilities to serve the growing geriatric population. PMID:21931453

  2. [Geriatric evaluation in oncology in the elderly subject].

    PubMed

    Albrand, G

    2009-11-01

    The heterogeneity of the elderly population makes the simple application of standard therapeutic programs in oncological management complex, particularly if they have been validated on young populations. The NCCN and the SIOG recommend using a geriatric evaluation before setting up an individualized care program. Geriatric assessment has demonstrated its efficacy in a number of domains. This concept covers two broad activities: the Multidimensional Geriatric Evaluation (MGE), which is a standardized geriatric evaluation for detecting co-morbidities and broad geriatric syndromes, and the Detailed Geriatric Evaluation (DGE). The objective of the DGE is to inventory the patient's various problems, distinguish somatic and/or psychiatric pathologies from the physiological consequences of aging, assess the functional impact of diseases, understand how these diseases interfere with one another, assess their consequences on the patient's social environment, and prioritize the patient's different health issues. The DGE is a medical action organized into five phases designed to set up care so that the recommendations made can be followed. PMID:20123505

  3. Review of efficacy and safety of laxatives use in geriatrics

    PubMed Central

    Izzy, Manhal; Malieckal, Anju; Little, Erin; Anand, Sury

    2016-01-01

    AIM: To study the efficacy and safety of pharmacological treatment of constipation in geriatrics. METHODS: PubMed, MEDLINE, google scholar, and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation, which were conducted between January 1990 and January 2013 using the specified keywords. Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included. Studies were excluded from this review if they were non-controlled trials, case series, or case reports. RESULTS: Out of twenty three studies we initially retrieved in our search, only nine studies met the eligibility criteria of being controlled trials within geriatrics. The laxatives examined in the nine studies were senna, lactulose, sorbital, polyethylene glycol (PEG), lubiprostone, linaclotide, and prucalopride. In those studies, senna combinations had a higher efficacy than sorbitol or lactulose as well as, a very good adverse effect profile. PEG was also shown to be safe and effective in geriatric population. Furthermore, it has been shown that PEG is as safe in geriatrics as in general population. New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrants further investigation. CONCLUSION: Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation. PMID:27158549

  4. [Quality assurance in geriatric rehabilitation--approaches and methods].

    PubMed

    Deckenbach, B; Borchelt, M; Steinhagen-Thiessen, E

    1997-08-01

    It did not take the provisions of the 5th Book of the Social Code for quality assurance issues to gain significance in the field of geriatric rehabilitation as well. While in the surgical specialties, experience in particular with external quality assurance have already been gathered over several years now, suitable concepts and methods for the new Geriatric Rehabilitation specialty are still in the initial stages of development. Proven methods from the industrial and service sectors, such as auditing, monitoring and quality circles, can in principle be drawn on for devising geriatric rehabilitation quality assurance schemes; these in particular need to take into account the multiple factors influencing the course and outcome of rehabilitation entailed by multimorbidity and multi-drug use; the eminent role of the social environment; therapeutic interventions by a multidisciplinary team; as well as the multi-dimensional nature of rehabilitation outcomes. Moreover, the specific conditions of geriatric rehabilitation require development not only of quality standards unique to this domain but also of quality assurance procedures specific to geriatrics. Along with a number of other methods, standardized geriatric assessment will play a crucial role in this respect. PMID:9411627

  5. [Impact of hospital diagnostic related groups on geriatric rehabilitation facilities].

    PubMed

    Kleinow, R; Hessel, F; Wasem, J

    2002-08-01

    The introduction of the DRGs (diagnosis related groups) for paying hospitals in Germany in 2003 will result in changes in quality, quantity and financial flows foremost for the hospital sector but also for the important sector of the geriatric rehabilitation. This geriatric sector will experience a growth in total patient numbers, an enhanced and altered service range and a change in the market relationship towards the hospitals. The introduction of case-related payments also for the geriatric rehabilitation could, on the one hand, reduce the negative spillover effects from the hospital sector and, on the other hand, guaranty an efficient service provision. Furthermore, there would be a good comparability among the geriatric rehabilitation facilities and between costs in institutions of geriatric rehabilitation and hospitals. If hospital and geriatric rehabilitation services were payed by case-related payments, efficiency of health care services could be further improved by a broad definition of cases (complex case-based reimbursement), including care in the hospital as well as the care in the rehabilitation clinic afterwards. If rehabilitation would be financed by case-based reimbursement as well as by of a complex case-based reimbursement, a quality assurance program would be necessary. PMID:12426882

  6. Radiation Oncology Medical Student Clerkship: Implementation and Evaluation of a Bi-institutional Pilot Curriculum

    SciTech Connect

    Golden, Daniel W.; Spektor, Alexander; Rudra, Sonali; Ranck, Mark C.; Krishnan, Monica S.; Jimenez, Rachel B.; Viswanathan, Akila N.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.

    2014-01-01

    Purpose: To develop and evaluate a structured didactic curriculum to complement clinical experiences during radiation oncology clerkships at 2 academic medical centers. Methods and Materials: A structured didactic curriculum was developed to teach fundamentals of radiation oncology and improve confidence in clinical competence. Curriculum lectures included: (1) an overview of radiation oncology (history, types of treatments, and basic clinic flow); (2) fundamentals of radiation biology and physics; and (3) practical aspects of radiation treatment simulation and planning. In addition, a hands-on dosimetry session taught students fundamentals of treatment planning. The curriculum was implemented at 2 academic departments in 2012. Students completed anonymous evaluations using a Likert scale to rate the usefulness of curriculum components (1 = not at all, 5 = extremely). Likert scores are reported as (median [interquartile range]). Results: Eighteen students completed the curriculum during their 4-week rotation (University of Chicago n=13, Harvard Longwood Campus n=5). All curriculum components were rated as extremely useful: introduction to radiation oncology (5 [4-5]); radiation biology and physics (5 [5-5]); practical aspects of radiation oncology (5 [4-5]); and the treatment planning session (5 [5-5]). Students rated the curriculum as “quite useful” to “extremely useful” (1) to help students understand radiation oncology as a specialty; (2) to increase student comfort with their specialty decision; and (3) to help students with their future transition to a radiation oncology residency. Conclusions: A standardized curriculum for medical students completing a 4-week radiation oncology clerkship was successfully implemented at 2 institutions. The curriculum was favorably reviewed. As a result of completing the curriculum, medical students felt more comfortable with their specialty decision and better prepared to begin radiation oncology residency.

  7. [The need for training in gerontology and geriatrics among the staff providing services at a geriatric care institution].

    PubMed

    Baerga Duperoy, Rachel; Castro Rojas, Nydia; Orta Rodríguez, Brenda; González Caraballo, Enid; Cruz González, Angel; Vázquez Fernández, José; Oliver Vázquez, Marlén

    2002-12-01

    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

  8. The Use of an Integrated Website to Enhance the Educational Experience in a Medical School Radiology Clerkship Course.

    PubMed

    Desai, Naman S; Bunch, Paul M; DiSalvo, Donald N; O'Brien, Reiko; Andriole, Katherine P; Smith, Terri; Durfee, Sara M

    2016-01-01

    The purpose of this study was to demonstrate the feasibility of creating an integrated website for the medical students enrolled in a core radiology clerkship and to assess the impact of this website on students' overall educational experience. An integrated website was created for the medical students and hosted on the main departmental website. The components of the website included: announcements and password-protected schedule, curriculum, student assessment, information about different radiology sections, digital resources, and fourth year opportunities. The schedule section was created using Google Calendar to facilitate automatic syncing and real-time updates to the students' mobile devices. Weblinks for resources and assignments were incorporated into the calendar entries, which could be "pushed" to students in real time. Student attitudes were assessed via an exit survey. Various website usage statistics were collected. A total of 35 students who have rotated through the month-long clerkship thus far have used the website. Overall, 80% of students accessed the website once or multiple times a day. Over 90% of students thought that the website was well organized and easy to use; having access to the schedule on a smartphone had a positive impact on overall clerkship experience; the website had an overall positive impact on their clerkship experience; and they would recommend it to visiting medical students. Since July 2013, there have been a total of 9740 page views with 4113 unique visits to the website (an average of 17 visits per day from 6 visitors per day). The authors conclude that the creation of an integrated website has a positive impact on students' overall educational experience. PMID:25896546

  9. Contrasting Effects of Geriatric Versus General Medical Multimorbidity on Quality of Ambulatory Care

    PubMed Central

    Min, Lillian; Kerr, Eve A.; Blaum, Caroline S.; Reuben, David; Cigolle, Christine; Wenger, Neil

    2015-01-01

    Objectives To determine whether greater burden of geriatric conditions would have contrasting effects on quality of care (QOC) than nongeriatric, general medical conditions. Design Cross-sectional observation over 1 year of ambulatory care Setting The Assessing Care of Vulnerable Elders-2 study Participants Older adults prospectively screened for falls, incontinence, and dementia (N=644). Measurements Participant-level QOC in absolute percentage points calculated using 65 ambulatory care care-process quality indicators (QIs) for 13 general medical and geriatric conditions (#QIs provided/# QIs eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QIs) and medical QOC (the 27 remaining nongeriatric QIs). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site. Results Medical and geriatric comorbidity were unrelated to each other (correlation coefficient=0.04, p=.27) yet had opposite effects on QOC. Each additional medical condition was associated with a 3.2-percentage point (95% confidence interval (CI)=2.3–4.2 percentage point) increment in QOC, and each additional geriatric condition was associated with 4.9-percentage point (95% CI=3.5–6.5 percentage point) decrement in QOC. Participants with greater geriatric comorbidity received poorer medical and geriatric QOC. Conclusion Greater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC. Geriatric multimorbidity should be targeted for better care using a comprehensive approach. PMID:25123154

  10. Adverse Geriatric Outcomes Secondary to Polypharmacy in a Mouse Model: The Influence of Aging.

    PubMed

    Huizer-Pajkos, Aniko; Kane, Alice E; Howlett, Susan E; Mach, John; Mitchell, Sarah J; de Cabo, Rafael; Le Couteur, David G; Hilmer, Sarah N

    2016-05-01

    We aimed to develop a mouse model of polypharmacy, primarily to establish whether short-term exposure to polypharmacy causes adverse geriatric outcomes. We also investigated whether old age increased susceptibility to any adverse geriatric outcomes of polypharmacy. Young (n= 10) and old (n= 21) male C57BL/6 mice were administered control diet or polypharmacy diet containing therapeutic doses of five commonly used medicines (simvastatin, metoprolol, omeprazole, acetaminophen, and citalopram). Mice were assessed before and after the 2- to 4-week intervention. Over the intervention period, we observed no mortality and no change in food intake, body weight, or serum biochemistry in any age or treatment group. In old mice, polypharmacy caused significant declines in locomotor activity (pre minus postintervention values in control 2±13 counts, polypharmacy 32±7 counts,p< .05) and front paw wire holding impulse (control -2.45±1.02 N s, polypharmacy +1.99±1.19 N s,p< .05), loss of improvement in rotarod latency (control -59±11 s, polypharmacy -1.7±17 s,p< .05), and lowered blood pressure (control -0.2±3 mmHg, polypharmacy 11±4 mmHg,p< .05). In young mice, changes in outcomes over the intervention period did not differ between control and polypharmacy groups. This novel model of polypharmacy is feasible. Even short-term polypharmacy impairs mobility, balance, and strength in old male mice. PMID:25940962

  11. Clinical Conundrums in Management of Hypothyroidism in Critically Ill Geriatric Patients

    PubMed Central

    Sehgal, Vishal; Bajwa, Sukhminder Jit Singh; Sehgal, Rinku; Bajaj, Anurag

    2014-01-01

    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

  12. Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome.

    PubMed

    Ahearn, David J; Umapathy, Dolores

    2015-02-01

    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 ?: 65years referred with dizziness or imbalance to an audiovestibular medicine clinic. Of 41 patients aged 65-93years 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

  13. An assisted living facility curriculum to introduce geriatrics to first-year medical students.

    PubMed

    Tong, Iris L; Dodd, Kimberly A; Warrier, Sarita S; Pugliese, Louis J; McMackin, Naomi Y; Taylor, Julie Scott

    2015-01-01

    Many U.S. medical schools have developed curricula in geriatric medicine to address the growing older adult population. At our university, the authors have integrated an assisted living facility (ALF) program into a required first-year clinical skills course. During the 2011 to 2012 academic year, an electronic survey was distributed to 109 first-year medical students prior to and after the program. Eighty-eight percent and 85% of students completed the pre- and postintervention survey, respectively. Students reported a positive attitude toward caring for older adults (92.5% post- vs. 80.2% preintervention), an understanding of the medical and social needs of older adults (89.2% post- vs. 38.5% preintervention), an acquisition of the skills to assess the health of older adults (71% post- vs. 14.5% preintervention), and an understanding of ALFs as nonmedical supportive housing (92.5% post- vs. 70.8% preintervention). The authors' curriculum offers an innovative method to integrate geriatrics education early in medical education and to involve medical students in their community. PMID:25203100

  14. The Relative Value Unit in academic geriatrics: incentive or impediment?

    PubMed

    Resnick, Neil M; Radulovich, Nichole

    2014-03-01

    Although the number of older adults is rapidly expanding, the number of healthcare professionals trained in geriatrics is small and declining. The reasons are multifaceted, but because responsibility for training such professionals resides largely in academic health centers (AHCs), their support for geriatrics is critical. As AHCs face increasing financial pressure, many are seeking metrics to measure productivity and the Relative Value Unit (RVU) may be the one most commonly selected. Yet little is known about the RVU's effect on geriatric programs. Review of the literature and a survey of the leaders of the Association of Directors of Geriatric Academic Programs suggest that the advantages of an RVU-based metric are likely eclipsed by its negative impact on the care of older adults, the ability of academic geriatrics to accomplish its mission, and even the survival of geriatrics. If the RVU is to continue to be used as the index of productivity, it should be modified--by reweighting its codes (or by adding new ones)--and complemented by interventions to ensure patient access, care quality, and efficiency. Because an alternative metric, such as a Patient-based Value Unit may be preferable, this article describes the principles on which one might be based. Regardless, urgent action is required by all stakeholders to address this issue. Without it, the future of academic geriatrics--and with it the innovative care models, research, and training the nation needs to improve care and bend the cost curve--will be difficult if not impossible to sustain. PMID:24512218

  15. Guide to Geriatric Syndromes: Common and Often Related Medical Conditions in Older Adults

    MedlinePlus

    ... Related Topics Cataracts Delirium Dementia Fainting (Syncope) Falls Prevention Geriatrics Glaucoma Macular Degeneration Nutrition Sleep Problems Urinary Incontinence Related Documents PDF A Guide to Geriatric Syndromes Download Join our ...

  16. [Measuring the handgrip strength of geriatric patients].

    PubMed

    Kerckhofs, A G M; Vandewoude, M F J; Mudde, A N

    2014-09-01

    The handgrip strength of geriatric patients can be measured when the patient is hospitalized. This article elaborates on the intrinsic and extrinsic factors which have a direct or indirect influence on handgrip strength. For the best results the tests need to be taken in the best circumstances with attention to individual differences and the age of the patient. Handgrip strength as determination of biological vitality is a key concept. Besides the physical characteristics there are many psychological factors (cognition, psyching-up, test attitude…) influencing the results. These are barely mentioned or not mentioned at all in the usual procedures. Research of handgrip strength testing theories is mostly focused on young, healthy adults and less on elderly patients. The main goal of this article is stimulating experimental research on the measurement of handgrip strength with elderly people and involving them more actively with the procedure. It is not enough to acquire insight in function and predicting characteristics of handgrip strength. Next to the aiming for the best test performance is 'working interactively with elderly patients' a goal on itself in the modern vision of health care. PMID:24827615

  17. Advances in caring for the older cancer patient: a report from the 2015 conference of the International Society of Geriatric Oncology

    PubMed Central

    Stepney, Rob

    2016-01-01

    A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology (SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.

  18. Altered Synchronizations among Neural Networks in Geriatric Depression

    PubMed Central

    Wang, Lihong; Chou, Ying-Hui; Potter, Guy G.; Steffens, David C.

    2015-01-01

    Although major depression has been considered as a manifestation of discoordinated activity between affective and cognitive neural networks, only a few studies have examined the relationships among neural networks directly. Because of the known disconnection theory, geriatric depression could be a useful model in studying the interactions among different networks. In the present study, using independent component analysis to identify intrinsically connected neural networks, we investigated the alterations in synchronizations among neural networks in geriatric depression to better understand the underlying neural mechanisms. Resting-state fMRI data was collected from thirty-two patients with geriatric depression and thirty-two age-matched never-depressed controls. We compared the resting-state activities between the two groups in the default-mode, central executive, attention, salience, and affective networks as well as correlations among these networks. The depression group showed stronger activity than the controls in an affective network, specifically within the orbitofrontal region. However, unlike the never-depressed controls, geriatric depression group lacked synchronized/antisynchronized activity between the affective network and the other networks. Those depressed patients with lower executive function has greater synchronization between the salience network with the executive and affective networks. Our results demonstrate the effectiveness of the between-network analyses in examining neural models for geriatric depression. PMID:26180795

  19. [The mobile geriatric team of Bretonneau Hospital and nursing home professionals].

    PubMed

    Braga, Charlotte; Chansiaux, Christine; Raynaud-Simon, Agathe

    2015-01-01

    In the wake of an experimental project, external mobile geriatric teams have been working in nursing homes in order to train the nursing teams in caring for geriatric pathologies. The mobile teams also give diagnostic and therapeutic recommendations in order to direct where necessary these dependent elderly people, often with multiple pathologies, towards geriatric care. PMID:26574127

  20. Three Strategies for Delivering Continuing Medical Education in Geriatrics to General Practitioners

    ERIC Educational Resources Information Center

    Rikkert, Marcel G. M.; Rigaud, Anne-Sophie

    2004-01-01

    General practitioners (GPs) need advanced skills in geriatric assessment to be competent to treat the increasing number of elderly patients. Continuing medical education in geriatrics for GPs is heterogeneous, and not assessed for effectiveness. In this study we compared the educational effects of three geriatric post-graduate training methods on

  1. Geriatric Pharmacy Curriculum in U.S. Pharmacy Schools: A Nationwide Survey.

    ERIC Educational Resources Information Center

    Simonson, William; Pratt, Clara Collette

    1982-01-01

    A survey of 72 pharmacy schools shows 22 percent of the schools had no geriatric coursework, 35 percent offered only courses in which the geriatric content averaged under 12 percent of course content, and 43 percent offered courses that focused primarily on geriatrics, most including a major clinical component. (Author/MSE)

  2. Fieldwork Rotation: A Model for Educating Social Work Students for Geriatric Social Work Practice

    ERIC Educational Resources Information Center

    Ivry, Joann; Lawrance, Frances P.; Damron-Rodriguez, JoAnn; Robbins, Virginia Cooke

    2005-01-01

    The Geriatric Social Work Practicum Partnership Program was funded to attract graduate students to the field of aging and to strengthen field education in geriatric social work. Rotation was selected to achieve the program's goals to provide students with exposure to the spectrum of care in geriatric social work services. This paper describes the…

  3. 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

    2011-01-01

    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,…

  4. 78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment The Department of... meeting of the Geriatrics and Gerontology Advisory Committee has been rescheduled on April 11-12, 2013, in... for Health on all matters pertaining to geriatrics and gerontology. The Committee assesses...

  5. 78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on April 10- 11, 2013, in Room 530 at the... Veterans Affairs and the Under Secretary for Health on all matters pertaining to geriatrics and...

  6. 77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-13

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on April 11- 12, 2012, in Room 530 at the... Veterans Affairs and the Under Secretary for Health on all matters pertaining to geriatrics and...

  7. 75 FR 11638 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-11

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on April 22- 23, 2010, in Room 630, Department of... Affairs and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology....

  8. 76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on April 14- 15, 2011, in Room 250, Department of... Affairs and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology....

  9. Three Strategies for Delivering Continuing Medical Education in Geriatrics to General Practitioners

    ERIC Educational Resources Information Center

    Rikkert, Marcel G. M.; Rigaud, Anne-Sophie

    2004-01-01

    General practitioners (GPs) need advanced skills in geriatric assessment to be competent to treat the increasing number of elderly patients. Continuing medical education in geriatrics for GPs is heterogeneous, and not assessed for effectiveness. In this study we compared the educational effects of three geriatric post-graduate training methods on…

  10. Managing a traumatic wound in a geriatric patient.

    PubMed

    Glenn, Josephine

    2006-04-01

    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

  11. Geriatric care and distributive justice: problems and prospects.

    PubMed

    Gill, D G; Ingman, S R

    1986-01-01

    This paper introduces a series of 16 essays on cross-national perspectives in geriatric care and distributive justice. Gill and Ingman first provide an overview of the "broad parameters under which distributive justice decisions have been and are being taken in the American medical care system," with special reference to John Rawls' A Theory of Justice. They then briefly summarize the topics of the other essays, which are organized into three sections: I. The U.S.A.: Underdevelopment of the Welfare State and Limited Geriatric Care; II. Nursing Homes: Industry or Public Service?; and III. Geriatric Care in Other Selected Countries. The authors conclude that funding health care for the elderly in terms of distributive justice is creating a dilemma for all societies. They propose the decommodification of medical services as a solution to the problem in the United States. PMID:3103243

  12. What to Expect From the Evolving Field of Geriatric Cardiology.

    PubMed

    Bell, Susan P; Orr, Nicole M; Dodson, John A; Rich, Michael W; Wenger, Nanette K; Blum, Kay; Harold, John Gordon; Tinetti, Mary E; Maurer, Mathew S; Forman, Daniel E

    2015-09-15

    The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients. PMID:26361161

  13. Geriatric epilepsy: research and clinical directions for the future.

    PubMed

    Roberson, Erik D; Hope, Omotola A; Martin, Roy C; Schmidt, Dieter

    2011-09-01

    There is a growing awareness of the need for improved treatment and care of older adults with epilepsy. The present review article highlights key clinical and research issues in the emerging field of geriatric epilepsy. Drs. Martin and Schmidt explore the scope of the problems in the field, outline topic areas including cognitive health/dementia, and diagnostic challenges, and also present important research questions that should be considered for the future. As part of this presentation, we will highlight the work of two promising young investigators whose work holds great promise for the field of geriatric epilepsy. Dr. Roberson will discuss his work focusing on the relationship of epilepsy and cognitive impairment, particularly as it relates to Alzheimer's disease pathology including tau and its role in epileptiform activity. Dr. Hope will outline key issues, as well as her work, relating to defining and measuring quality care in geriatric epilepsy. PMID:21596624

  14. The Relative Value Unit in Academic Geriatrics: Incentive or Impediment?

    PubMed Central

    Resnick, Neil M.; Radulovich, Nichole

    2016-01-01

    Although the number of older adults is rapidly expanding, the number of healthcare professionals trained in geriatrics is small and declining. The reasons are multifaceted, but because responsibility for training such professionals resides largely in academic health centers (AHCs), their support for geriatrics is critical. As AHCs face increasing financial pressure, many are seeking metrics to measure productivity and the Relative Value Unit (RVU) may be the one most commonly selected. Yet little is known about the RVU’s effect on geriatric programs. Review of the literature and a survey of the leaders of the Association of Directors of Geriatric Academic Programs suggest that the advantages of an RVUbased metric are likely eclipsed by its negative impact on the care of older adults, the ability of academic geriatrics to accomplish its mission, and even the survival of geriatrics. If the RVU is to continue to be used as the index of productivity, it should be modified—by reweighting its codes (or by adding new ones)—and complemented by interventions to ensure patient access, care quality, and efficiency. Because an alternative metric, such as a Patient-based Value Unit may be preferable, this article describes the principles on which one might be based. Regardless, urgent action is required by all stakeholders to address this issue. Without it, the future of academic geriatrics—and with it the innovative care models, research, and training the nation needs to improve care and bend the cost curve—will be difficult if not impossible to sustain. PMID:24512218

  15. Economic viability of geriatric hip fracture centers.

    PubMed

    Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph

    2013-12-01

    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

  16. Research priorities in geriatric palliative care: policy initiatives.

    PubMed

    Unroe, Kathleen T; Meier, Diane E

    2013-12-01

    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

  17. Fried frailty phenotype assessment components as applied to geriatric inpatients

    PubMed Central

    Bieniek, Joanna; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status. Objective The aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group. Patients and methods: Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men), participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients. Results Multimorbidity (6.0±2.8 diseases) characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores). All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8–69.2) (diagnostic group). One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group) because of lack of past patient’s body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini-Mental State Examination and Barthel Index of Activities of Daily Living. Despite diagnostic limitations, we found ≥3 positive criteria (thus, frailty diagnosis) in 54.2% of the study group (95% CI =49.8–58.6), with prevalence from 31.7% in sexagenarians to 67.6% in nonagenarians. Conclusion Fried frailty phenotype criteria seem useful for geriatric inpatient assessment, despite diagnostic limitations. High prevalence of frailty among geriatric inpatients suggests that evaluation for frailty should be considered a part of the comprehensive geriatric assessment. PMID:27217729

  18. Using tablets to support self-regulated learning in a longitudinal integrated clerkship

    PubMed Central

    Alegría, Dylan Archbold Hufty; Boscardin, Christy; Poncelet, Ann; Mayfield, Chandler; Wamsley, Maria

    2014-01-01

    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

  19. Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group.

    PubMed

    Camina-Martín, M Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, J Antonio; Redondo-del-Río, M Paz

    2015-07-01

    Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, because elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología, SEGG) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories seeks to aid in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment associated to laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is to further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. PMID:26025067

  20. [Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group].

    PubMed

    Camina-Martín, María Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, José Antonio; Redondo-Del-Río, María Paz

    2016-01-01

    Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. PMID:26388249

  1. Nuclear Medicine

    MedlinePlus

    ... for Parents/Teachers Resource Links for Students Glossary Nuclear Medicine What is nuclear medicine? What are radioactive ... NIBIB-funded researchers advancing nuclear medicine? What is nuclear medicine? Nuclear medicine is a medical specialty that ...

  2. Graduate and Undergraduate Geriatric Dentistry Education in a Selected Dental School in Japan

    PubMed Central

    Kitagawa, Noboru; Sato, Yuji; Komabayashi, Takashi

    2010-01-01

    Geriatric dentistry and its instruction are critical in a rapidly aging population. Japan is the world’s fastest-aging society, and thus geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed to evaluate geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographic data and local information were collected. Descriptive and statistical analyses (Fisher and Chi-square test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There was no significant differences found between the number of public and private dental schools with geriatric dentistry departments (p = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students’ geriatric dental education curriculum (p=0.077). Graduate geriatric education is unique because it is a four-year Ph.D. course of study; there is neither a Master’s degree program nor a certificate program in Geriatric Dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry. PMID:21985207

  3. Florida State University College of Medicine: from ideas to outcomes.

    PubMed

    Fogarty, John P; Littles, Alma B; Romrell, Lynn J; Watson, Robert T; Hurt, Myra M

    2012-12-01

    The Florida State University College of Medicine (FSU COM) was established in 2000, the first new MD-granting medical school in the United States in over 25 years. In its brief history, the FSU COM has developed rapidly in accordance with its founding mission to meet the need for primary care physicians, especially those caring for the elderly and the underserved. The school recently received a full continuation of accreditation for the maximum period, eight years, from the Liaison Committee on Medical Education.The authors describe FSU COM's new, innovative educational program using community-based clinical training on six statewide regional campuses and two rural sites. Third- and fourth-year students are assigned to community physicians in a one-on-one clinical training model in all of the settings where physicians practice. Over 70% of student clinical training is in such settings. The authors describe how the model operates, including curricular oversight (which ensures quality and equivalence of the educational experience at all sites), the regional campus structure, administration, education program delivery during core clerkships, and assessment of students' performance. Ongoing required faculty development for all clerkship faculty is an essential feature of the training program, as is tracking of all individual student contacts through an online clinical data collection system used for evaluation of the clerkship experiences as well as research.The authors demonstrate that the school has been highly successful in implementing its mission, and that the challenge ahead is to sustain its approach to the training of future physicians. PMID:23095920

  4. Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review

    PubMed Central

    Carpenter, Christopher R.; Avidan, Michael S.; Wildes, Tanya; Stark, Susan; Fowler, Susan A.; Lo, Alexander X.

    2015-01-01

    Background Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. Objectives This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor’s accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. Methods A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. Results A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. Conclusions This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk PMID:25293956

  5. Multi-institutional development and utilization of a computer-assisted learning program for the pediatrics clerkship: the CLIPP Project.

    PubMed

    Fall, Leslie H; Berman, Norman B; Smith, Sherilyn; White, Christopher B; Woodhead, Jerold C; Olson, Ardis L

    2005-09-01

    Computer-assisted instruction (CAI) holds significant promise for meeting the current challenges of medical education by providing consistent and quality teaching materials regardless of training site. The Computer-assisted Learning in Pediatrics Project (CLIPP) was created over three years (2000-2003) to meet this potential through multi-institutional development of interactive Internet-based patient simulations that comprehensively teach the North American core pediatrics clerkship curriculum. Project development adhered to four objectives: (1) comprehensive coverage of the core curriculum; (2) uniform approach to CAI pedagogy; (3) multi-institutional development by educators; and (4) extensive evaluation by users. Pediatrics clerkship directors from 30 institutions worked in teams to develop a series of 31 patient case simulations. An iterative process of case content and pedagogy development, case authoring, peer review, and pilot-testing ensured that the needs of clerkship directors and medical students were met. Fifty medical schools in the United States and Canada are presently using CLIPP. More than 8,000 students have completed over 98,000 case sessions, with an average of 2,000 case sessions completed per week at this time. Each CLIPP case has been completed by more than 3,000 students. The current cost of CLIPP development is approximately $70 per student user, or $6 per case session. The project's success demonstrates that multi-institutional development and implementation of a peer-reviewed comprehensive CAI learning program by medical educators is feasible and provides a useful model for other organizations to develop similar programs. Although CAI development is both time-consuming and costly, the initial investment decreases significantly with broad use over time. PMID:16123465

  6. Evaluation of preceptors and skills achievement by clinical pharmacy clerkship students during their clinical rotations at University of Gondar, Ethiopia

    PubMed Central

    Belachew, Sewunet Admasu; Abegaz, Tadesse Melaku; Bhagavathula, Akshaya Srikanth; Getachew, Henok; Tefera, Yonas Getaye

    2016-01-01

    Aim To investigate the overall experiences of clinical pharmacy students during their clinical attachments and to understand the breadth and depth of clinical skills provided by their preceptors. Methods A cross-sectional study using a self-administered questionnaire containing 34 items to obtain feedback from the clerkship students from June to July 2015. Data analysis was performed to calculate mean, standard deviation, percentages, and multiple logistic regression using Statistical Package for the Social Sciences (SPSS) software Version 22. Statistical significance was set at P<0.01. Results All 58 clerkship students actively participated in the study, yielding a response rate of 100%. While students ranked their clerkship experience as moderate, >15% remarked that they did not receive enough opportunities to hone their pharmaceutical care documentation skills. A relatively high percentage of students (32.8%) strongly agreed that their preceptors had provided ample opportunity to discuss the patient problems at the bedside and encouraged them to express their opinions regarding patients’ drug therapeutic issues. This study also revealed that students’ continuity in developing their therapeutic and disease process knowledge was significantly associated with the preceptor’s ability to provide adequate training and orientation (P =0.01), engagement in clinical pharmacy activities (P =0.01), regular review of students’ work (P =0.01), and instruction to students before entering clinical sites (P =0.00). Conclusion The findings of this study reveal that a majority of the students were moderately satisfied with the clinical training program and preceptors need to demonstrate effective pharmaceutical care processes in their clinical sites. PMID:27099540

  7. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries

    PubMed Central

    Bajwa, Sukhminder Jit Singh

    2015-01-01

    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. PMID:25810963

  8. 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

    2003-01-01

    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…

  9. Geriatric syndromes and assessment in older cancer patients.

    PubMed

    Naeim, A; Reuben, D

    2001-12-01

    Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore, cancer treatment can worsen geriatric syndromes. It is often difficult to determine whether declining health is a result of cancer treatment or the patient's underlying disease. Baseline assessment of multiple factors may facilitate detection of a decline in the patient's health status, which may be remediable. Geriatric syndromes may substantially affect quality of life and are also important in the prognosis and outcome of cancer therapy. This article reviews the assessment of cognitive syndromes (dementia and delirium), vision and hearing impairment, gait and balance difficulties, malnutrition, incontinence, depression, osteoporosis, sleep disorders, environmental and social issues, and functional decline. Although there are many geriatric domains and many focused assessment tools, assessment does not need to be time-consuming. Streamlined assessment tools have been developed; they are brief, inexpensive, and easily administered, and they may be valuable to the oncologist. Staff such as nurses, social workers, or office personnel could perform these assessments and minimize the impact on the physician's time. PMID:11780701

  10. Maximizing the Potential of Internships in Gerontology and Geriatrics

    ERIC Educational Resources Information Center

    Karasik, Rona J.

    2009-01-01

    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

  11. Health Promotion/Disease Prevention: New Directions for Geriatric Education.

    ERIC Educational Resources Information Center

    Levkoff, Sue; And Others

    1996-01-01

    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…

  12. Neuroplasticity-Based Computerized Cognitive Remediation for Geriatric Depression

    PubMed Central

    Morimoto, Sarah Shizuko; Wexler, Bruce E.; Alexopoulos, George S.

    2012-01-01

    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

  13. Integrating Geriatric Dentistry into General Practice Residency Programs.

    ERIC Educational Resources Information Center

    Lloyd, Patrick M.; Shay, Kenneth

    1989-01-01

    The predoctoral dental curriculum cannot provide the depth of experience and knowledge needed for the increasing representation of geriatric patients in family dental practices. A curriculum model designed to enhance knowledge and refine clinical skills in caring for the elderly is proposed. (MSE)

  14. Development of the Geriatric Oral Health Assessment Index.

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; Dolan, Teresa A.

    1990-01-01

    This paper describes the rationale for and the development of the Geriatric Oral Health Assessment Index (GOHAI). The GOHAI has demonstrated a high level of internal consistency and reliability. Poor GOHAI scores were significantly correlated to having fewer teeth, wearing a removable denture, and perceiving the need for dental treatment.

  15. Maximizing the Potential of Internships in Gerontology and Geriatrics

    ERIC Educational Resources Information Center

    Karasik, Rona J.

    2009-01-01

    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…

  16. Medical Readers' Theater: Relevance to Geriatrics Medical Education

    ERIC Educational Resources Information Center

    Shapiro, Johanna; Cho, Beverly

    2011-01-01

    Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

  17. Geriatric Education in the Health Professions: Are We Making Progress?

    ERIC Educational Resources Information Center

    Bardach, Shoshana H.; Rowles, Graham D.

    2012-01-01

    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…

  18. Use of Readers Theater to Enhance Interdisciplinary Geriatric Education

    ERIC Educational Resources Information Center

    MacRae, Nancy; Pardue, Karen T.

    2007-01-01

    This article focuses on the design and implementation of an interdisciplinary geriatric educational project at a small New England University. A novel, affective teaching approach of Readers Theater is highlighted as a beginning classroom instructional strategy for interdisciplinary students. The physical and psychosocial considerations for health…

  19. E-Learning Virtual Patients for Geriatric Education

    ERIC Educational Resources Information Center

    Orton, Eric; Mulhausen, Paul

    2008-01-01

    Computer-based virtual patients (VPs) are an emerging medium for medical education that addresses barriers faced by geriatrics educators. Research has shown VPs to be as effective in changing knowledge and behavior as more traditional forms of teaching. This paper presents a descriptive study of the development of the University of Iowa's…

  20. A Web-Based Framework for Improving Geriatric Education

    ERIC Educational Resources Information Center

    Hirth, Victor A.; Hajjar, Ihab

    2004-01-01

    Despite the growth in the elderly population, physicians with special geriatric training and certification number only 9,000 out of 650,000 doctors in the United States. The flexibility and increasing availability of the Internet makes it an ideal avenue for addressing the educational needs of health care providers to improve the health and care…

  1. Objective Structured Video Examinations (OSVEs) for Geriatrics Education

    ERIC Educational Resources Information Center

    Simpson, Deborah; Gehl, Suzanne; Helm, Robin; Kerwin, Diana; Drewniak, Theresa; Bragg, Dawn St. A.; Ziebert, Monica M.; Denson, Steven; Brown, Diane; Heffron, Mary Gleason; Mitchell, Julie; Harsch, Harold H.; Havas, Nancy; Duthie, Edmund, Jr.; Denson, Kathryn

    2006-01-01

    The Medical College of Wisconsin (MCW) and the Wisconsin Geriatric Education Center (WGEC) are committed to developing educational materials for primary care physicians in training. In response to the opportunity created by the Accreditation Council for Graduate Medical Education (ACGME) competency mandate, an MCW-led interdisciplinary working…

  2. An Interdisciplinary Teaching Program in Geriatrics for Physician's Assistants.

    ERIC Educational Resources Information Center

    Stark, Ruth; And Others

    1984-01-01

    Describes a beginning course in clinical geriatrics for medical students and student physician's assistants, physical therapists and nurse practitioners. The course will increase students' ability to identify basic physical, psychological, and social characteristics of the normal aging process; and to recognize prevalent myths and negative…

  3. Geriatric Training Needs of Nursing-Home Physicians

    ERIC Educational Resources Information Center

    Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur

    2009-01-01

    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

  4. Factors Influencing Depression among Elderly Patients in Geriatric Hospitals.

    PubMed

    Jee, Young Ju; Lee, Yun Bok

    2013-11-01

    [Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem scale, a social support scale, and a life satisfaction scale. Data were collected from April 20 to June 20, 2011. Data were analyzed using descriptive statistics, Pearson correlations, and multiple logistic regression analysis using SPSS 15.0 and Stata 11.0. [Results] The average GDSSF-K score of the participants was 8.94, indicating a moderate level of depression. About 78.4% of the elderly patients in this study were classified as predisposed toward depression. Significant predictors for depression included the patients' perceived health status and life satisfaction. [Conclusion] The results indicate that elderly patients face a high risk of developing depression and that efforts should be made to address it wherever possible. Regular depression screening will be beneficial for early detection of depression in patients at community geriatric hospitals. PMID:24396207

  5. Facial fractures and bone healing in the geriatric patient.

    PubMed

    Friedman, C D; Costantino, P D

    1990-12-01

    A discussion of the biology of bone healing serves as the basis for a review of the clinical management of maxillofacial skeletal injury in the geriatric patient. Age-related changes in the facial skeleton and fractures of the edentulous mandible are described in detail. PMID:2074984

  6. Novel ethical dilemmas arising in geriatric clinical practice.

    PubMed

    Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peña, Carmen; Altamirano-Bustamante, Myriam M

    2015-05-01

    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

  7. Geriatric Training Needs of Nursing-Home Physicians

    ERIC Educational Resources Information Center

    Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur

    2009-01-01

    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…

  8. [Managing pressure ulcers in palliative care in geriatric units].

    PubMed

    Forasassi, Christine; Meaume, Sylvie

    2015-01-01

    Many elderly people at the end of life, in geriatric units, suffer from pressure ulcers despite preventive care. Measures are put in place in order to prevent the occurrence of new pressure ulcers and to define a local and general treatment strategy for those already occured . The priority remains to relieve the pain and improve the patient's comfort and quality of life. PMID:26027187

  9. [Patient satisfaction and geriatric care - an empirical study].

    PubMed

    Clausen, G; Borchelt, M; Janssen, C; Loos, S; Mull, L; Pfaff, H

    2006-02-01

    Patients' satisfaction has become a central concept in quality assurance. Despite progress in research in this area is still a lack of data for geriatric patients. Referring to the consumer model, satisfaction can be described as a difference between expectations and assessed performance. The aim of this study is to analyze satisfaction among geriatric patients in an in-patient setting. A personal interview was performed 1-2 days before discharge. Patients suffering for dementia or with problems to communicate were excluded. 124 of 268 geriatric patients who were discharged in 2003 were included (inclusion rate 46.3%). 119 were willing to participate (response rate 96.0%). Respondents were between 61 and 96 years old, 39% were male and 42% had serious functional limitations at time of admission. Multiple linear regression analysis revealed three significant predictors of a combined index of satisfaction and expectations: a) quality of hotel services; b) experience of neglect; c) provision of medical information and skills. In summary, standardized personal questionnaires can provide valid and reliable data of geriatric patients. Satisfaction of elderly patients is negatively affected by neglect and positively influenced by provision of medical information and a good hotel services. PMID:16502227

  10. Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents.

    PubMed

    Ying Fong, Yoly Yeuk; Yu, Marco; Young, Alvin Lerrmann; Jhanji, Vishal

    2015-09-01

    We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents. PMID:26356724

  11. Assessment of reproductive behavior and hormonal cycles in geriatric western Lowland gorillas.

    PubMed

    Margulis, Susan W; Atsalis, Sylvia; Bellem, Astrid; Wielebnowski, Nadja

    2007-03-01

    The population of western lowland gorillas in North American zoos is aging and, as is the case with the aging human population, may have unique physical and social needs. We have documented previously that 25% of aging females (5/22) ceased to show reproductive cycles entirely, and could be defined as menopausal. Approximately 32% of females showed somewhat irregular cycling patterns. We review our hormonal and behavioral findings on reproductive aging in gorillas; describe the range of cycling patterns that we see and how we interpret these; and discuss the implications of these findings for captive management and husbandry of aging gorillas. We monitored fecal hormone metabolites (progestogens) in 30 gorillas and collected simultaneous behavioral data to evaluate the relationship between cyclicity and sexual behavior. We identified and described several discrete patterns of irregular cycling. These included extreme variability of cycle length, cyclic patterns with unusually low progestogen peak concentrations that possibly may not support luteal activity, and large variability in maximum progestogen peak height among cycles. All of these changes are consistent with age-related hormonal changes observed in humans and may be signs of changes in fertility as well. Behaviorally, nearly all cycling females exhibited signs of estrus. Affiliative behavior between male silverbacks and estrous females was observed in the control females, but not the geriatric females. These findings suggest that pre-menopausal females are exhibiting signs of perimenopause. As is the case in humans, such changes in hormone patterns may occur years before the onset of menopause. As enhancements in nutrition, husbandry, and veterinary medicine have led to increased longevity in our zoo populations of apes, it has become imperative that we investigate and better understand associated physiological and behavioral changes in geriatric animals to ensure appropriate management of this increasing demographic sub-population. Zoo Biol 0:1-23, 2007. (c) 2007 Wiley-Liss, Inc. PMID:19360566

  12. 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.

    2011-01-01

    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)…

  13. Standardization of Course Plan and Design of Objective Structured Field Examination (OSFE) for the Assessment of Pharm.D. Student’s Community Pharmacy Clerkship Skills

    PubMed Central

    Monajjemzadeh, Farnaz; Shokri, Javad; Mohajel Nayebi, Ali Reza; Nemati, Mahboob; Azarmi, Yadollah; Charkhpour, Mohammad; Najafi, Moslem

    2014-01-01

    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

  14. Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education

    PubMed Central

    Sricharoen, Pungkava; Yuksen, Chaiyaporn; Sittichanbuncha, Yuwares; Sawanyawisuth, Kittisak

    2015-01-01

    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

  15. Exercise programs for fitness and health for geriatrics.

    PubMed

    Johnson, C R

    1999-04-01

    "As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above 'thresholds' of physical ability, needing only minor intercurrent illness to render them completely dependent" (Astrand, 1992, p. 1231S). The NP can play a crucial role in educating motivating, and encouraging geriatric clients to continue or initiate a fitness program. The exercise program that is prescribed by NPs for their patients "depends on their needs, goals, physical and health status, personal preference, and available time, equipment, and facilities" (Pollack et al., 1994, p. 588). Fitness is a goal for all geriatric patients, that they might remain healthy and physically fit longer, and therefore continue to lead active, fulfilling lives. PMID:10504927

  16. [The functional assessment as comprehensive geriatric assessment axis].

    PubMed

    Casado Verdejo, Inés; Iglesias Guerra, José Antonio

    2013-01-01

    The comprehensive geriatric assessment (VGI) is a diagnostic process dynamic, structured, multidimensional and interdisciplinary to detect problems and needs of older people to develop an intervention strategy, although scientific evidence should not apply to all groups elderly. The VGI is developed by an interdisciplinary team, which plays a key role nursing. The framework nurse and nursing conceptual models, especially the 11 functional health patterns, enable the multidimensional assessment and subsequent intervention. The VGI covers four areas, clinic, mental, social and functional, although its axis, its importance and globalization concept is functional assessment. For this we have the history, physical examination and a series of specific instruments, geriatric assessment scales. They are a complement to, not only the VGI axis. PMID:23951672

  17. Geriatric Rehabilitation Patients’ Perceptions of Unit Dining Locations

    PubMed Central

    Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne

    2014-01-01

    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

  18. [Successful aging: what can neurology and geriatrics contribute?].

    PubMed

    Synofzik, M; Maetzler, W

    2015-04-01

    The relative proportion of elderly persons in Western societies is rapidly growing, leading to an increasing frequency of age-related neurological diseases (e.g. dementia) and functional impairments (e.g. immobility). This article argues that this development should prompt a new focus in medical care. The key questions should not only be how can we improve treatment of age-related disorders but also how can we prevent age-related disorders in the first place or at least substantially delay their onset? These questions touch on an even more profound question: how can successful aging be accomplished? That is, which factors and processes characterize successful aging both on a system and on a molecular level? Thus, the crucial societal, scientific and medical challenges for Western societies are to develop and implement measures of primary prevention of dysfunctional aging. The disease-centered framework which currently determines most clinical thinking, scientific research and third party funding has to be supplemented by a novel framework of successful aging. This article defines dysfunctional aging as a convergent downstream result of multiple interacting system processes. Each of these detrimental system processes must be targeted by specific measures of geriatric primary prevention. This, in turn, implies that geriatrics does not start in the elderly or with the onset of particular geriatric disorders. Instead, it starts in the daily practice of neurology and other medical disciplines taking care of persons aged 20-40 years who are largely healthy and in the middle of their professional and personal career. Or, in a nutshell, geriatrics starts right in the middle of medical care. PMID:25801949

  19. [The role of nursing care in geriatric rehabilitation].

    PubMed

    Kämmer, K

    1992-01-01

    This article intends to present goals, tasks and focus points in different kinds of institutions of geriatric rehabilitation. This is be done under the aspects of: 1. Accompanying handicappeds during their disease. 2. Nursing orientated of activities in daily life. 3. Nursing with a multiprofessional team and its role within the rehabilitative concept. Besides this, goals and development strategies in professional nursing will be worked out. PMID:1413965

  20. [Chronic Constipation: A Geriatric Syndrome with Urological Implications].

    PubMed

    Füsgen, I; Wiedemann, A

    2016-02-01

    Chronic constipation, faecal and urinary incontinence are a geriatric syndrome. Chronic constipation is particularly important for the field of urology as it may be considered to trigger urological incontinence problems. Both chronic constipation and urinary incontinence are age-dependent symptoms, which are associated with a significant impact on quality of life. Chronic constipation must be taken into consideration during the diagnostic work-up and treatment of urinary incontinence. PMID:26574951

  1. Home Teaching of the Geriatric Blind. Final Research Report.

    ERIC Educational Resources Information Center

    Gobetz, Giles Edward; And Others

    A three-year home-teaching demonstration project with the geriatric blind was conducted with 171 clients in the experimental group (132 were blind for 10 years or less and were 60 years of age or older, 11 were blind 17 years or longer, 7 were in an apartment group, 7 died, and 14 had incomplete records) and 44 clients in the control group. The…

  2. Evidence-based practices in geriatric mental health care.

    PubMed

    Bartels, Stephen J; Dums, Aricca R; Oxman, Thomas E; Schneider, Lon S; Areán, Patricia A; Alexopoulos, George S; Jeste, Dilip V

    2002-11-01

    The past decade has seen dramatic growth in research on treatments for the psychiatric problems of older adults. An emerging evidence base supports the efficacy of geriatric mental health interventions. The authors provide an overview of the evidence base for clinical practice. They identified three sources of evidence-evidence-based reviews, meta-analyses, and expert consensus statements-on established and emerging interventions for the most common disorders of late life, which include depression, dementia, substance abuse, schizophrenia, and anxiety. The most extensive research support was found for the effectiveness of pharmacological and psychosocial interventions for geriatric major depression and for dementia. Less is known about the effectiveness of treatments for the other disorders, although emerging evidence is promising for selected interventions. Empirical support was also found for the effectiveness of community-based, multidisciplinary, geriatric psychiatry treatment teams. The authors discuss barriers to implementing evidence-based practices in the mental health service delivery system for older adults. They describe approaches to overcoming these barriers that are based on the findings of research on practice change and dissemination. Successful approaches to implementing change in the practices of providers emphasize moving beyond traditional models of continuing medical education to include educational techniques that actively involve the learner, as well as systems change interventions such as integrated care management, implementation toolkits, automated reminders, and decision support technologies. The anticipated growth in the population of older persons with mental disorders underscores the need for a strategy to facilitate the systematic and effective implementation of evidence-based practices in geriatric mental health care. PMID:12407270

  3. 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

    2011-01-01

    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…

  4. Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training.

    PubMed

    Maggiore, Ronald J; Gorawara-Bhat, Rita; Levine, Stacie K; Dale, William

    2014-01-01

    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

  5. [Thromboses and haemorrhages in geriatrics (author's transl)].

    PubMed

    de Nicola, P E

    1976-01-01

    In elderly patients thromboses are especially important because of their frequency and consequences (invalidity) often demanding measures of rehabilitation. In thrombophilia there are prophylactic measures necessary founding upon new perceptions on pathogenesis (vascular wall factors; rheologic and microcirculatory factors and factors of hemostasis: increasing of factor VIII; decreasing of antithrombin III; hypofibrinolysis; increased aggregation of thrombocytes). In prophylaxis you should influence the predisposing factors (hypertension, diabetes, arteriosclerosis, adipositas), use dietetic and hygienic measures and also from the pharmalogical point medicines with complex effect, which not only act on one factor (blood coagulation) like the anticoagulants, but also on other pre-disposing factors; and at the same time activate the fibrinolysis and stop the aggregation of thrombocytes. Thrombolytica should be used in elderly patients with precaution. In hemorrhages in the age especially capillary protecting medicaments should be used to correct the increased fragility of capillaries. Of there is at the some time a arteriosclerosis, hypertension, diabetes mellitus, obesity. PMID:1014738

  6. Geriatric hip fracture clinical pathway: the Hong Kong experience

    PubMed Central

    Leung, F.; Siu, D.; Wong, G.; Luk, K. D. K.

    2010-01-01

    Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures. PMID:19543764

  7. Food intakes and preferences of hospitalised geriatric patients

    PubMed Central

    Shahar, Suzana; Chee, Kan Yin; Wan Chik, Wan Chak Pa'

    2002-01-01

    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

  8. How to Implement a Geriatric Assessment in Your Clinical Practice

    PubMed Central

    Sattar, Schroder; Alibhai, Shabbir M.H.; Wildiers, Hans

    2014-01-01

    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

  9. An etiologic profile of anemia in 405 geriatric patients.

    PubMed

    Geisel, Tabea; Martin, Julia; Schulze, Bettina; Schaefer, Roland; Bach, Matthias; Virgin, Garth; Stein, Jürgen

    2014-01-01

    Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy. PMID:24707396

  10. Geriatric palliative care: do medical students' narrative reflections after a hospice clinical experience link to geriatric competencies?

    PubMed

    Corcoran, Amy M; True, Gala; Charles, Natasha; Margo, Katherine L

    2013-01-01

    Since the Association of American Medical Colleges geriatric competencies were released, educators are striving to incorporate them into medical student curricula. The purpose of this study is to examine medical students' reflections after an interdisciplinary, hospice staff-precepted clinical experience, and whether these reflections relate to the geriatric competencies which focus on palliative care. From July 2010 to June 2011, 155 2nd- and 3rd-year medical students participated in a required, half-day hospice experience, with 120 (77%) submitting narrative reflections for analysis. The narratives were analyzed using the constant comparative method associated with grounded theory, followed by consensus-building in an iterative process, to identify themes. Six themes were identified from the analysis of student narratives: demonstrating a new or expanded knowledge of hospice care (79%, 95/120), developing new insights about self and others (74%, 89/120), changing attitudes toward hospice care (63%, 76/120), linking patient needs with appropriate team members (43%, 52/120), understanding patient goals of care (43%, 51/120), and discussing palliative care as a treatment option (27%, 32/120). The authors conclude that a brief, interdisciplinary, hospice staff-precepted clinical experience is an effective model to inspire medical students to reflect on geriatric palliative care. Students clearly reflected on the geriatric palliative care competencies of symptom assessment and management, and gained insight into the role of the hospice team members and how hospice care can be a positive treatment option. Future educators should think about building on this type of high impact learning experience, and developing items to measure application of knowledge gained. PMID:23972213

  11. Multidimensional Geriatric Prognostic Index, Based on a Geriatric Assessment, for Long-Term Survival in Older Adults in Korea

    PubMed Central

    Jung, Hee-Won; Han, Ji Won; Kim, Kayoung; Kim, Jee Hyun; Kim, Kwang-Il; Kim, Cheol-Ho

    2016-01-01

    The patient´s survival estimate is important for clinical decision-making, especially in frail patients with multimorbidities. We aimed to develop a multidimensional geriatric prognosis index (GPI) for 3- and 5-year mortality in community-dwelling elderly and to validate the GPI in a separate hospital-based population. The GPI was constructed using data for 988 participants in the Korean Longitudinal Study on Health and Aging (KLoSHA) and cross-validated with 1109 patients who underwent a geriatric assessment at the Seoul National University Bundang Hospital (SNUBH). The GPI, with a total possible score of 8, included age, gender, activities of daily living, instrumental activities of daily living, comorbidities, mood, cognitive function, and nutritional status. During the 5-year observation period, 179 KLoSHA participants (18.1%) and 340 SNUBH patients (30.7%) died. The c-indices for 3- and 5-year mortality were 0.78 and 0.80, respectively, in the KLoSHA group and 0.73 and 0.80, respectively, in the SNUBH group. Positive linear trends were observed for GPI scores and both 3- and 5-year mortality in both groups. In conclusions, using common components of a geriatric assessment, the GPI can stratify the risk of 3- and 5-year mortality in Korean elderly people both in the community and hospital. PMID:26771562

  12. Multidimensional Geriatric Prognostic Index, Based on a Geriatric Assessment, for Long-Term Survival in Older Adults in Korea.

    PubMed

    Jung, Hee-Won; Kim, Jin Won; Han, Ji Won; Kim, Kayoung; Kim, Jee Hyun; Kim, Kwang-Il; Kim, Cheol-Ho; Kim, Ki Woong

    2016-01-01

    The patient´s survival estimate is important for clinical decision-making, especially in frail patients with multimorbidities. We aimed to develop a multidimensional geriatric prognosis index (GPI) for 3- and 5-year mortality in community-dwelling elderly and to validate the GPI in a separate hospital-based population. The GPI was constructed using data for 988 participants in the Korean Longitudinal Study on Health and Aging (KLoSHA) and cross-validated with 1109 patients who underwent a geriatric assessment at the Seoul National University Bundang Hospital (SNUBH). The GPI, with a total possible score of 8, included age, gender, activities of daily living, instrumental activities of daily living, comorbidities, mood, cognitive function, and nutritional status. During the 5-year observation period, 179 KLoSHA participants (18.1%) and 340 SNUBH patients (30.7%) died. The c-indices for 3- and 5-year mortality were 0.78 and 0.80, respectively, in the KLoSHA group and 0.73 and 0.80, respectively, in the SNUBH group. Positive linear trends were observed for GPI scores and both 3- and 5-year mortality in both groups. In conclusions, using common components of a geriatric assessment, the GPI can stratify the risk of 3- and 5-year mortality in Korean elderly people both in the community and hospital. PMID:26771562

  13. [Effects of family medicine education on medical students' attitudes].

    PubMed

    Chou, M C; Lee, M C

    1991-07-01

    Undergraduate education is considered to be one of the main contributory factors for the development of family medicine through increasing the number of medical graduates opting for a career in family practice. To evaluate the effects of family medicine education on student's attitudes, 140 fifth year medical students were asked in 1989 to fill in a questionnaire both before and after their curricula. The average age of the 123 students who completed the questionnaire on both occasions was 24.9 years; 106 were males; 17 were tuition free and 26 took additional family medicine clerkships. On aggregate, the students' disposition toward family medicine before their curricula appeared to be uncertain. Mean scores on the attitude scale did not significantly differ between socioeconomic subgroups before the curricula. After the curricula, students' attitudes were significantly altered, especially toward the future development of family medicine in Taiwan. However, their disposition toward family practice as a career changed the least. The degree of alteration in students' attitude toward family medicine before and after the curricula was related to the intensity of the course and to their socioeconomic backgrounds. PMID:1875456

  14. Perceptions of pharmacy clerkship students and clinical preceptors regarding preceptors’ teaching behaviors at Gondar University in Ethiopia

    PubMed Central

    2016-01-01

    This study aimed to compare the perceptions of pharmacy clerkship students and clinical preceptors of preceptors’ teaching behaviors at Gondar University. A cross-sectional study was conducted among pharmacy clerkship students and preceptors during June 2014 and December 2015. A 52-item structured questionnaire was self-administered to 126 students and 23 preceptors. The responses are presented using descriptive statistics. The Mann-Whitney U test was applied to test the significance of differences between students and preceptors. The response rate was 89.4% for students and 95.6% for preceptors. Statistically significant differences were observed in the responses regarding two of the five communication skills that were examined, six of the 26 clinical skills, and five of the 21 parameters involving feedback. The mean scores of preceptors (2.6/3) and students (1.9/3) regarding instructors’ ability to answer questions were found to be significantly different (P= 0.01). Students and preceptors gave mean scores of 1.9 and 2.8, respectively, to a question regarding preceptors’ application of appropriate up-to-date knowledge to individual patients (P= 0.00). Significant differences were also noted between students and instructors regarding the degree to which preceptors encouraged students to evaluate their own performance (P= 0.01). Discrepancies were noted between students and preceptors regarding preceptors’ teaching behaviors. Preceptors rated their teaching behaviors more highly than students did. Short-term training is warranted for preceptors to improve some aspects of their teaching skills. PMID:26971864

  15. 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.

    2009-01-01

    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…

  16. 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

    2008-01-01

    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

  17. The Success and Struggles of Filipino Geriatric Nurses in Nursing Homes

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Coronel, Rona Denise V.; Chua, Kannerin O.; Constantino, Mariz G.; Cordova, Ericsann James C.

    2009-01-01

    Geriatric nursing is a physically and emotionally demanding job in healthcare. It is a neglected field despite the growing population of the elderly, and the experiences of geriatric nurses are one of the unrecognized aspects of this field. This qualitative study purports to explore the successes and struggles of the lived experiences of a select

  18. 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

    2012-01-01

    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…

  19. 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

    2008-01-01

    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

  20. A Community-Based Approach for Integrating Geriatrics and Gerontology into Undergraduate Medical Education

    ERIC Educational Resources Information Center

    Martinez, Iveris L.; Mora, Jorge Camilo

    2012-01-01

    Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences.…

  1. [Benefit of a geriatric mobile team in the emergency departments: a ten-year review].

    PubMed

    Natali, Jean-Philippe; Schwald, Nathalie; Bach, Frdrique; Bourgouin, Galle; Chiffray, Dominique; Bloch, Frdric

    2015-01-01

    Ageriatric mobile team was created in the emergency department of Cochin Hospital in Paris, in 2005. This key player in the multi-disciplinary management of elderly patients in the emergency department and in the geriatric care pathway, showed, during its 10-year of existence, its utility. PMID:26574128

  2. 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.

    2009-01-01

    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…

  3. 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

    2008-01-01

    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…

  4. 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

    2013-01-01

    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…

  5. Successful Implementation of a Faculty Development Program in Geriatrics for Non-Primary Care Physician Educators

    ERIC Educational Resources Information Center

    Williams, Brent C.; Schigelone, Amy R.; Fitzgerald, James T.; Halter, Jeffrey B.

    2008-01-01

    A four-year faculty development program to enhance geriatrics learning among house officers in seven surgical and related disciplines and five medical subspecialties at a large academic institution resulted in changes in attitudes and knowledge of faculty participants, expanded curricula and teaching activities in geriatrics, and enhanced and…

  6. The Success and Struggles of Filipino Geriatric Nurses in Nursing Homes

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Coronel, Rona Denise V.; Chua, Kannerin O.; Constantino, Mariz G.; Cordova, Ericsann James C.

    2009-01-01

    Geriatric nursing is a physically and emotionally demanding job in healthcare. It is a neglected field despite the growing population of the elderly, and the experiences of geriatric nurses are one of the unrecognized aspects of this field. This qualitative study purports to explore the successes and struggles of the lived experiences of a select…

  7. Geriatric Expertise among Medical School Faculty: Preparing for the Challenges of an Aging Population

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Jenkins, Carol L.; Eleazer, G. Paul; Kelsey, Susan G.

    2007-01-01

    This study examined non-geriatrician physicians' experiences in a geriatrics-focused faculty development program, and effects of the program on their geriatrics knowledge and their teaching and practice. In-depth interviews were conducted with all physicians (n = 26) participating in the Dean's Faculty Scholars in Aging program. Most participants…

  8. Community Psychiatrists Who See Geriatric Patients: What's Training Got to Do with It?

    ERIC Educational Resources Information Center

    Lieff, Susan; Andrew, Melissa; Tiberius, Richard

    2004-01-01

    Objective: This study examines the issues influencing psychiatrists' decisions to provide care to the under-served geriatric population. Methods: Community-based psychiatrists who see geriatric patients participated in focus group discussions exploring factors that influence the characteristics of their current practices. Results: Personal themes,…

  9. Cognitive Deficits in Geriatric Depression: Clinical Correlates and Implications for Current and Future Treatment

    PubMed Central

    Morimoto, Sarah Shizuko; Alexopoulos, George S.

    2013-01-01

    Synopsis The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression, and describe their clinical significance. We then summarize the complex relationship between geriatric depression and dementia and discuss possible shared mechanisms. Last, we present evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation. PMID:24229654

  10. 77 FR 49865 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-17

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on September 5-6, 2012, in Room C-7 at the... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet...

  11. 78 FR 55778 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on September 26-27, 2013, in Room 530 at the... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet...

  12. 75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on September 14-15, 2010, in Room 250, Department... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet...

  13. 76 FR 54536 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ... AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting The Department of Veterans... Geriatrics and Gerontology Advisory Committee will be held on September 15-16, 2011, in Room 250 at the... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet...

  14. Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

    ERIC Educational Resources Information Center

    Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea

    2012-01-01

    The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…

  15. 9 CFR 381.157 - Canned boned poultry and baby or geriatric food.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Canned boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Standards of Identity or Composition § 381.157 Canned boned poultry and baby or geriatric food. (a)...

  16. 9 CFR 381.157 - Canned boned poultry and baby or geriatric food.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Canned boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Standards of Identity or Composition § 381.157 Canned boned poultry and baby or geriatric food. (a)...

  17. Successful Implementation of a Faculty Development Program in Geriatrics for Non-Primary Care Physician Educators

    ERIC Educational Resources Information Center

    Williams, Brent C.; Schigelone, Amy R.; Fitzgerald, James T.; Halter, Jeffrey B.

    2008-01-01

    A four-year faculty development program to enhance geriatrics learning among house officers in seven surgical and related disciplines and five medical subspecialties at a large academic institution resulted in changes in attitudes and knowledge of faculty participants, expanded curricula and teaching activities in geriatrics, and enhanced and

  18. Impairment in Instrumental Activities of Daily Living and the Geriatric Syndrome of Self-Neglect

    ERIC Educational Resources Information Center

    Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.

    2008-01-01

    Purpose: We sought to characterize self-neglect definitively as a geriatric syndrome by identifying an association with functional impairment. Design and Methods: We performed a cross-sectional home evaluation of 100 community-living older adults referred by Adult Protective Services for geriatric self-neglect and 100 matched adults from a…

  19. Nuclear Medicine.

    ERIC Educational Resources Information Center

    Badawi, Ramsey D.

    2001-01-01

    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)

  20. Aerospace Medicine

    NASA Technical Reports Server (NTRS)

    Michaud, Vince

    2015-01-01

    NASA Aerospace Medicine overview - Aerospace Medicine is that specialty area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space.

  1. Birds of a feather: introducing a virtual learning community for geriatric nurse educators.

    PubMed

    Egerton, Emily O; McConnell, Eleanor S; Corazzini, Kirsten; Kitzmiller, Rebecca R; Crook, Jonathon O

    2010-05-01

    The Duke Geriatric Nursing Education Virtual Learning Community (Gero-VLC) is a newly developed online inquiry network that enables geriatric nurse educators to borrow, share, and collaborate to promote in-depth learning and optimal communication among instructors. Recently launched, the Gero-VLC website was developed to meet the needs of nurse educators who face increasing demands to develop quality, learner-centered online instruction focused on evidence-based geriatric care. Through the Gero-VLC, nurse educators can connect with nurse clinicians expert in geriatric care; access state-of-the-science information and learning opportunities; participate in collaborative projects; and publish their work on the North Carolina Learning Object Repository. The authors present the Gero-VLC as a best practice for online geriatric nursing education, describe its theoretical underpinnings, and outline a strategy for evaluation. PMID:20481420

  2. 'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions

    PubMed Central

    2012-01-01

    Background Comprehensive geriatric assessment has been shown to improve patient outcomes, but the geriatricians who deliver it are in short-supply. A web-based method of comprehensive geriatric assessment has been developed with the potential to improve access to specialist geriatric expertise. The current study aims to test the reliability and safety of comprehensive geriatric assessment performed "online" in making geriatric triage decisions. It will also explore the accuracy of the procedure in identifying common geriatric syndromes, and its cost relative to conventional "live" consultations. Methods/Design The study population will consist of 270 acutely hospitalized patients referred for geriatric consultation at three sites. Paired assessments (live and online) will be conducted by independent, blinded geriatricians and the level of agreement examined. This will be compared with the level of agreement between two independent, blinded geriatricians each consulting with the patient in person (i.e. "live"). Agreement between the triage decision from live-live assessments and between the triage decision from live-online assessments will be calculated using kappa statistics. Agreement between the online and live detection of common geriatric syndromes will also be assessed using kappa statistics. Resource use data will be collected for online and live-live assessments to allow comparison between the two procedures. Discussion If the online approach is found to be less precise than live assessment, further analysis will seek to identify patient subgroups where disagreement is more likely. This may enable a protocol to be developed that avoids unsafe clinical decisions at a distance. Trial registration Trial registration number: ACTRN12611000936921 PMID:22433175

  3. Psychosocial work load and stress in the geriatric care

    PubMed Central

    2010-01-01

    Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database). Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration). Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity. A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties. Conclusions Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs. PMID:20663137

  4. [Geriatric patients with chronic kidney insufficiency: which antalgia?].

    PubMed

    Ionescu, M; Hemett, O M; Descombes, E; Blondel, N; Hayoz, D

    2014-04-01

    Pain is a leading cause of office visits. In the geriatric population, it is known that the prevalence of renal failure increases exponentially with age, modifing the elimination of drugs and of their metabolites. What analgesia should be offered to these patients? The holy grail would be a medication without renal elimination, without toxic metabolites and without nephrotoxicity. Based on the literature we try to propose a specific approach to analgesia in older patients with kidney insufficiency, in order to help practitioners to better prescribe for this group of patients. PMID:24791426

  5. Prevalence of delirium in geriatric hospitalized general medical population.

    PubMed

    Khurana, Paramjeet Singh; Sharma, P S V N; Avasthi, Ajit

    2002-01-01

    The present study was carried out on the hospitalised geriatric general medical patients. The assessment of the patients was carried out within 24 hours of admission and on every fourth day thereafter using Mini Mental Status Examination (MMSE), Confusion Assessment Method (CAM), Delirium Symptom Interview (DSI) and ICD-10-Diagnostic Criteria of Research for delirium. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. 19% was the rate of 'prevalent' delirium and 8% was the rate of 'incident' delirium. It is observed that the CAM is a useful screening method with high sensitivity for diagnosis of delirium at the bedside. PMID:21206880

  6. Pain Management Issues for the Geriatric Surgical Patient.

    PubMed

    McKeown, Jason L

    2015-09-01

    Adequate treatment of pain is of utmost importance in making uncomplicated the perioperative course for geriatric surgical patients. Effective analgesia reduces morbidity, improves patient and family satisfaction, and is a natural expectation of high-quality care. Pain treatment in older adults is more complicated than in younger counterparts, and great consideration must be given to age-related changes in physiology and pharmacokinetics. Pain treatment must be individualized based on each patient's profile. Side effects must be minimized and organ toxicity avoided. When complications occur they may be more severe, and treatment must be prompt. Alternative plans for analgesia must be readily enacted. PMID:26315638

  7. Structures and geriatrics from a failure analysis experience viewpoint

    SciTech Connect

    Hopper, D.M. )

    1993-05-01

    In a failure analysis consulting engineering practice one sees a variety of structural failures from which observations may be made concerning geriatric structures. Representative experience with power plants, refineries, offshore structures, and forensic investigations is summarized and generic observations are made regarding the maintenance of fitness for purpose of structures. Although it is important to optimize the engineering design for a range of operational and environmental variables, it is essential that fabrication and inspection controls exist along with common sense based ongoing monitoring and operations procedures. 18 figs.

  8. An autonomy supportive model of geriatric team function.

    PubMed

    Powers, J S; White, S; Varnell, L; Turvy, C; Kidd, K; Harrell, D; Knight, B; Floyd, K; Zupko, K

    2000-08-01

    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

  9. Short-term geriatric assessment units: 30 years later

    PubMed Central

    2010-01-01

    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

  10. Absence of Streptococcus pneumoniae in pharyngeal swabs of geriatric inpatients.

    PubMed

    Jomrich, Nina; Kellner, Silvia; Djukic, Marija; Eiffert, Helmut; Nau, Roland

    2015-07-01

    Colonization of the pharynx by Streptococcus pneumoniae was studied in 185 in-hospital geriatric patients (median age 81 years) from 29 March 2011 to 22 June 2011. Swabs were plated on blood agar plates. Colonies with a morphology suggesting S. pneumoniae were further analyzed. Surprisingly, pneumococci were not found in any of the samples. Pneumococci chronically colonizing the pharynx of elderly people may be much rarer than previously thought and probably are not the source of pneumococcal pneumonia in old age. PMID:25746605

  11. Looking forward in geriatric anxiety and depression: implications of basic science for the future.

    PubMed

    Gershenfeld, Howard K; Philibert, Robert A; Boehm, Gary W

    2005-12-01

    Major depression and anxiety are common psychiatric illnesses whose etiology remains incompletely understood. This review highlights progress in understanding the etiology of these illnesses through genetic strategies and looks forward to their impact on geriatric psychiatry. We briefly address three broad domains of progress, namely 1) genetic approaches to etiology, including linkage and association studies, pharmacogenetics ("personalized medicine"), and gene x environment interactions; 2) mechanisms of thyroid and testosterone action via nuclear receptors, given these hormones' status as possible augmenters of antidepressants; and 3) the role of the neuroimmune system as a contributor to the stress response. Genetic strategies offer one path for converting correlational findings into causal pathways while complementing studies of a gene's function at the molecular, cellular, network, and whole-organismal levels. Neuroendocrine supplementation (thyroid and testosterone) has a long history and tradition. A molecular understanding of nuclear receptor pathways and their coactivators, the mediator complex proteins, provides a rationale for improved targeting of hormonal action in a tissue-selective manner, yielding drugs with improved safety and efficacy. Neural-immune interactions in psychiatric illness remain tantalizing topics. Research suggests that cytokine pathways may contribute to the maintenance or susceptibility to stress, anxiety, and depressive disorders. The reciprocal and recursive interactions among basic science, drug discovery, and clinical science will continue to provide hopeful themes for improving the lives of patients with treatment-refractive psychiatric illness. PMID:16319295

  12. The geriatric management of frailty as paradigm of "The end of the disease era".

    PubMed

    Cesari, Matteo; Marzetti, Emanuele; Thiem, Ulrich; Pérez-Zepeda, Mario Ulises; Abellan Van Kan, Gabor; Landi, Francesco; Petrovic, Mirko; Cherubini, Antonio; Bernabei, Roberto

    2016-06-01

    The sustainability of healthcare systems worldwide is threatened by the absolute and relative increase in the number of older persons. The traditional models of care (largely based on a disease-centered approach) are inadequate for a clinical world dominated by older individuals with multiple (chronic) comorbidities and mutually interacting syndromes. There is the need to shift the center of the medical intervention from the disease to the biological age of the individual. Thus, multiple medical specialties have started looking with some interest at concepts of geriatric medicine in order to better face the increased complexity (due to age-related conditions) of their average patient. In this scenario, special interest has been given to frailty, a condition characterized by the reduction of the individual's homeostatic reserves and increased vulnerability to stressors. Frailty may indeed represent the fulcrum to lever for reshaping the healthcare systems in order to make them more responsive to new clinical needs. However, the dissemination of the frailty concept across medical specialties requires a parallel and careful consideration around the currently undervalued role of geriatricians in our daily practice. PMID:26997416

  13. Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012

    PubMed Central

    2012-01-01

    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.

  14. Estimating Geriatric Mortality after Injury Using Age, Injury Severity, and Performance of a Transfusion: The Geriatric Trauma Outcome Score

    PubMed Central

    Zhao, Frank Z.; Wolf, Steven E.; Nakonezny, Paul A.; Minhajuddin, Abu; Rhodes, Ramona L.; Paulk, M. Elizabeth

    2015-01-01

    Abstract Background: A tool to determine the probability of mortality for severely injured geriatric patients is needed. Objective: We sought to create an easily calculated geriatric trauma prognostic score based on parameters available at the bedside to aid in mortality probability determination. Methods: All patients ≥65 years of age were identified from our Level I trauma center's registry between January 1, 2000 and December 31, 2013. Measurements included age, Injury Severity score (ISS), units of packed red blood cells (PRBCs) transfused in the first 24 hours, and patients' mortality status at the end of their index hospitalization. As a first step, a logistic regression model with maximum likelihood estimation and robust standard errors was used to estimate the odds of mortality from age, ISS, and PRBCs after dichotomizing PRBCs as yes/no. We then constructed a Geriatric Trauma Outcome (GTO) score that became the sole predictor in the re-specified logistic regression model. Results: The sample (n=3841) mean age was 76.5±8.1 years and the mean ISS was 12.4±9.8. In-hospital mortality was 10.8%, and 11.9% received a transfusion by 24 hours. Based on the logistic regression model, the equation with the highest discriminatory ability to estimate probability of mortality was GTO Score=age+(2.5×ISS)+22 (if given PRBCs). The area under the receiver operating characteristic curve (AUC) for this model was 0.82. Selected GTO scores and their related probability of dying were: 205=75%, 233=90%, 252=95%, 310=99%. The range of GTO scores was 67.5 (survivor) to 275.1 (died). Conclusion: The GTO model accurately estimates the probability of dying, and can be calculated at bedside by those possessing a working knowledge of ISS calculation. PMID:25974408

  15. Heart failure - medicines

    MedlinePlus

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  16. Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics)

    PubMed Central

    2011-01-01

    Background Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity. Methods/Design Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up. Discussion The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct evidence on the effect of a DMP in elderly patients with HF and high comorbidty, and will reduce the need to extrapolate the results of clinical trials in adults to elderly patients. Trial registration (ClinicalTrials.gov number, NCT01076465). PMID:21819564

  17. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement: American Geriatrics Society Ethics Committee.

    PubMed

    2015-03-01

    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

  18. Geriatric depression and its relation with cognitive impairment and dementia.

    PubMed

    Dillon, Carol; Tartaglini, María Florencia; Stefani, Dorina; Salgado, Pablo; Taragano, Fernando E; Allegri, Ricardo F

    2014-01-01

    Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p<0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p<0.05) were found in DLA between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression. PMID:24855979

  19. Chronic diseases in captive geriatric female Chimpanzees (Pan troglodytes).

    PubMed

    Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L

    2012-04-01

    The current aging population of captive chimpanzees is expected to develop age-related diseases and present new challenges to providing their veterinary care. Spontaneous heart disease and sudden cardiac death are the main causes of death in chimpanzees (especially of male animals), but little is known about the relative frequency of other chronic diseases. Furthermore, female chimpanzees appear to outlive the males and scant literature addresses clinical conditions that affect female chimpanzees. Here we characterize the types and prevalence of chronic disease seen in geriatric (older than 35 y) female chimpanzees in the colony at Alamogordo Primate Facility. Of the 16 female chimpanzees that fit the age category, 87.5% had some form of chronic age-related disease. Cardiovascular-related disease was the most common (81.25%) followed by metabolic syndrome (43.75%) and renal disease (31.25%). These data show the incidence of disease in geriatric female chimpanzees and predict likely medical management challenges associated with maintaining an aging chimpanzee population. PMID:22546920

  20. A systematic approach to the pharmacotherapy of geriatric major depression

    PubMed Central

    Mulsant, Benoit H.; Blumberger, Daniel M.; Ismail, Zahinoor; Rabheru, Kiran; Rapoport, Mark J.

    2014-01-01

    SYNOPSIS While about 14% of older Americans are now taking an antidepressant, this broad use of antidepressants has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. First, we discuss and reject the possible explanations that antidepressants are not effective in the treatment of depression or that the results of randomized clinical trials are not applicable to the treatment of depression in “real-world” clinical settings. Instead, we propose that the efficacy of antidepressants depends in large part on the way they are used. We present evidence supporting that the use of antidepressant pharmacotherapy is associated with better outcomes when it is guided by a treatment algorithm (a “stepped care approach”) as opposed to an attempt to individualize treatment. We review published guidelines and pharmacotherapy algorithms that were developed for the treatment of geriatric depression. Finally, we propose an updated algorithm based on the authors’ interpretation of the available evidence. PMID:25037293

  1. Poor oral health, a potential new geriatric syndrome.

    PubMed

    van der Putten, Gert-Jan; de Baat, Cees; De Visschere, Luc; Schols, Jos

    2014-02-01

    This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome. PMID:24446975

  2. Antimicrobial Stewardship for a Geriatric Behavioral Health Population.

    PubMed

    Ellis, Kristen; Rubal-Peace, Georgina; Chang, Victoria; Liang, Eva; Wong, Nicolas; Campbell, Stephanie

    2016-01-01

    Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit. PMID:27025523

  3. Clinical preference for factors in treatment of geriatric depression

    PubMed Central

    Riepe, Matthias W

    2015-01-01

    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

  4. FKBP5 Polymorphisms and Antidepressant Response in Geriatric Depression

    PubMed Central

    Sarginson, Jane E.; Lazzeroni, Laura C.; Ryan, Heather S.; Schatzberg, Alan F.; Murphy, Greer M.

    2010-01-01

    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

  5. Incontinence-associated dermatitis and pressure ulcers in geriatric patients.

    PubMed

    Kottner, J; Beeckman, D

    2015-12-01

    The key characteristics of geriatric patients are advanced age, multimorbidity, a decrease of psychical performance and care dependency. In addition, advanced age, chronic and acute diseases and treatments (e.g. polypharmacy) lead, either directly or indirectly, to a wide range of skin and tissue problems. Incontinence-associated dermatitis and pressure ulcers (PUs) belong to the most prevalent in geriatric settings. Prolonged exposure of the skin to urine and/or stool can cause an irritant contact dermatitis. Skin surface 'wetness', increased skin surface pH, digestive intestinal enzymes, repeated skin cleansing activities, and a possible occlusive environment contribute to irritation and inflammation. Prevention and treatment includes activities to maintain and to enhance continence and to limit, to reduce exposure of the skin to urine and stool, and to promote healing and reepithelialisation. In frail aged skin, it is recommended to use incontinence products with smooth and breathable materials with maximum absorption capacity. Immediate skin cleansing after soiling using mild cleansers and protective and caring leave-on products are recommended. PUs are localized injuries to the skin and/or underlying tissue caused by sustained deformations of skin and underlying soft tissues. PUs management includes risk assessment, repositioning and mobilization, and the use of appropriate support surfaces. Patients must be never positioned directly on an existing PU. Especially at end of life, the PU closure and wound healing may not be the primary therapeutic goal. PMID:26186379

  6. Barriers to Implementation of an Organized Geriatric Fracture Program

    PubMed Central

    Kates, Stephen L.; O’Malley, Natasha; Friedman, Susan M.; Mendelson, Daniel A.

    2012-01-01

    Introduction: There has been a recent increase in interest in implementing organized geriatric fracture programs for care of older adults with fragility fractures in order to improve both the quality and costs of care. Because such programs are relatively new, there are no standardized methods for implementation and no published descriptions of barriers to implementation. Materials and Methods: An online survey tool was sent to 185 surgeons and physicians practicing in the United States, who are involved with geriatric fracture care. Sixty-eight responses were received and evaluated. Results: Barriers identified included lack of medical and surgical leadership, need for a clinical case manager, lack of anesthesia department support, lack of hospital administration support, operating room time availability, and difficulty with cardiac clearance for surgery. Other issues important to implementation included quality improvement, cost reductions, cost to the hospital, infection prevention, readmission prevention, and dealing with competing interest groups and competing projects mandated by the government. Physicians and surgeons felt that a site visit to a functioning program was most important when considering implementing a hip fracture program. Conclusions: This study provides useful insights into barriers to implementing an organized hip fracture program. The authors offer suggestions on ways to mitigate or overcome these barriers. PMID:23569692

  7. Acute care delivery for the geriatric patient: an innovative approach.

    PubMed

    Collard, A F; Bachman, S S; Beatrice, D F

    1985-06-01

    As the elderly population and expenditures for health care continue to grow rapidly in the United States, how to provide high-quality, cost-effective geriatric care is becoming a pressing question. To address this question, Choate-Symmes Health Services, Inc, established 10-bed Geriatric Special Care Units (GSCUs) in its two suburban Boston hospitals. Care on the GSCUs is delivered under a primary nursing model and involves comprehensive assessment, development of individual care plans emphasizing independence and activity, an interdisciplinary patient care team, and family participation in care planning. Patients were randomly assigned to either the GSCU or a traditional adult medical/surgical unit; outcomes were studied through questionnaires and medical record data. Researchers anticipated improved functional ability, less frequent use of restraints, fewer complications, shorter lengths of stay, and less frequent readmission to the hospital or admission to nursing homes for GSCU patients. The article presents preliminary results, discusses implementation issues, and describes plans for continued study. PMID:3939598

  8. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    PubMed Central

    Ellis, Kristen; Rubal-Peace, Georgina; Chang, Victoria; Liang, Eva; Wong, Nicolas; Campbell, Stephanie

    2016-01-01

    Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit. PMID:27025523

  9. Where does research occur in geriatrics and gerontology?

    PubMed

    Navarro, Albert; Lynd, Frances E

    2005-06-01

    The International Plan of Action on Aging 2002 emphasized the need to promote and develop research on aging, especially in underdeveloped countries. This article aims at describing the current situation with regard to the international scientific production in the field of geriatrics and gerontology. All articles published in journals included in the categories "Geriatrics and Gerontology" of the Science Citation Index or "Gerontology" of the Social Science Citation Index in 2002 were analyzed. There is unquestionable predomination by the United States, which participates in 53.8% of the articles analyzed, followed by the United Kingdom (9.66%) and Canada (6.66%). The production of the 15 European Union countries together is 31.2%. When adjustments are made for economic or population factors, other countries show their importance: Israel and Sweden, for example. Authors from richer countries participate in more than 95% of the articles, whereas those in less-developed countries tend to publish less, and when they do so, it is through collaboration with more-developed countries. In general, only 10.5% of the articles are written in collaboration with institutions from different countries. One of the keys to stimulating research in less wealthy countries would seem to be precisely through collaboration. This would aid the transfer of knowledge and experience, allowing researchers in these countries to obtain autonomy to perform their own studies independently and to provide them with the ability to gain access for their publications at the international level. PMID:15935034

  10. Geriatric Small Bowel Obstruction: An Analysis of Treatment and Outcomes Compared to a Younger Cohort

    PubMed Central

    Krause, William R.; Webb, Travis P.

    2016-01-01

    Background Small bowel obstruction (SBO) is a common condition, but little is known about its presentation, management, and outcomes in geriatric patients. Methods A retrospective review was performed comparing geriatric (≥65 years of age) and non-geriatric patients admitted with SBO. Admission characteristics, treatment, and outcomes were compared. Data analysis included Student’s t test and chi-square test or Fisher exact test. Results Among 80 geriatric and 136 non-geriatric patients no difference was observed between admission characteristics, treatment, time to or type of surgery, length of post-op stay, or overall complications. Cardiac complications (15% vs 0%, p=0.0082) and sub-acute care facility discharge (29% vs 5%, p<0.001) were more common for geriatric patients. Conclusions Compared to younger adults, elderly patients with SBO have similar presentations and overall outcomes with the exception of cardiac morbidity and discharge disposition. Pre-operative attention to cardiac risk profile and discharge disposition discussion should be encouraged. Summary This study analyzes geriatric patients presenting with small bowel obstruction when cared for by an Acute Care Surgery service. Compared to younger adults, the presentation, treatment response, and outcomes are similar with the exception of cardiac complications and discharge destination. PMID:25048569

  11. Dental care in geriatric patients—a cross-sectorial service

    PubMed Central

    Lerch, Michael; Mertens, Matthias; Decker-Maruska, Mechthild

    2010-01-01

    Purpose Evaluation of a customer-designed dental service network across the service sectors for geriatric patients. Context The lack in accessibility of dental services and the non-awareness of possible dental causes to medical problems by clinicians often prevents the geriatric patient from receiving the dental care needed. In cooperation with the Dental Board a geriatric dentist was appointed, multi-professional rounds, training in oral hygiene organized and a documentation system for cross-references to other medical conditions and the nutritional status implemented. Data source The scientific evaluation of >280 geriatric dental patients from 2008 to 2009 (22 with original teeth, 260 with dentures, 88 with denture problems, 32 with other affections). Case description Upon admission patients are screened for dental problems. Possible problems are seen by the specially trained geriatric dentist. The patient’s dental problems are photo-documented and than cross-referenced to his overall medical condition in a common documentation sheet for an overview of possible dental causes, the nutritional situation or other conditions. Conclusion and discussion The integration of a special geriatric dental service, using competence from across the sectors of medical care lead to an improved level of dental care and oral hygiene in the geriatric patients and better inter-professional understanding.

  12. Referral to specialized geriatric services. Which elderly people living in the community are likely to benefit?

    PubMed Central

    Man-Son-Hing, M.; Power, B.; Byszewski, A.; Dalziel, W. B.

    1997-01-01

    PROBLEM BEING ADDRESSED: As the Canadian population ages, family physicians encounter increasing numbers of elderly people with medical, functional, psychological, and social difficulties. In the past two decades, most regions of Canada have developed systems of specialized geriatric services, available on a consultative basis, to assist family physicians evaluating and managing elderly patients with these difficulties. For many family physicians, however, it is often unclear which of their elderly patients are likely to benefit from referral to these geriatric services. OBJECTIVE OF PROGRAM: Using an interdisciplinary approach, specialized geriatric services seek to optimize health, maximize function, promote independence, and prevent or delay institutionalization of elderly people. Yet not all elderly people benefit from referral to specialized geriatric services. This article offers a clear and clinically practical framework to help family physicians identify elderly patients in their practices who are likely to benefit from referral to specialized geriatric services. MAIN COMPONENTS OF PROGRAM: By synthesizing previous work on the concept of frail elderly persons into a 2 x 2 matrix, the level and intensity of geriatric intervention most appropriate for different segments of the elderly population is clarified. CONCLUSIONS: Using the simple approach described in this article, family physicians should be able to use available geriatric resources easily and efficiently to optimize the health and function of their elderly patients. PMID:9154364

  13. Oral Examination: A Model for Its Use within a Clinical Clerkship.

    ERIC Educational Resources Information Center

    Vu, Nu V.; And Others

    1981-01-01

    The Department of Obstetrics and Gynecology at the Southern Illinois University School of Medicine has devised an evaluation system that not only provides the advantages of oral examination but also attempts to alleviate some of its disadvantages. The system uses oral examination to assess students' content knowledge. (MLW)

  14. A Structured Curriculum for an Undergraduate Elective Clerkship in Pediatric Nephrology

    ERIC Educational Resources Information Center

    Rauch, Jerome S.; Schwartz, M. William

    1977-01-01

    An organizational structure was developed at the University of Pennsylvania School of Medicine for a pediatric nephrology elective. A study guide and format ensure that students have a common knowledge base--the lack of which has been a problem in electives--and allows them to participate in patient problems. (LBH)

  15. The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.

    PubMed

    Filinson, Rachel; Clark, Phillip G; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    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

  16. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression.

    PubMed

    Riva-Posse, Patricio; Hermida, Adriana P; McDonald, William M

    2013-12-01

    Geriatric depression is associated with increased mortality because of suicide and decreases in functional and physical health. Many elders' depression is resistant to psychotherapy and medication and can become chronic. Electroconvulsive therapy (ECT) is increasingly used in the treatment of medication-resistant or life-threatening geriatric depression. Neuromodulation therapies (subconvulsive, focal, or subconvulsive and focal) are alternatives for the management of treatment-resistant depression in the elderly. Therapies that combine both strategies could be safer but may not be as effective as ECT. This review covers the evidence on the safety and efficacy of ECT and the neuromodulation therapies in geriatric depression. PMID:24229660

  17. Geriatric Impairments and Disability: The Cardiovascular Health Study

    PubMed Central

    Chaudhry, Sarwat I.; McAvay, Gail; Ning, Yuming; Allore, Heather G.; Newman, Anne B.; Gill, Thomas M.

    2010-01-01

    Objectives Our objective was to determine the relative importance of geriatric impairments (including those in muscle strength, physical capacity, cognition, vision, hearing and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses. Design We analyzed longitudinal data from the Cardiovascular Health Study. Multivariable Cox hazards regression modeling was used to analyze associations between time-dependent predictors and onset of disability in Activities of Daily Living (ADL) and mobility. Setting/Participants 5888 community-dwelling elderly persons were followed for up to seven years. Intervention N/A Measurements Data were collected annually through in-person examinations. Results ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios of having 1, 2, and ≥ 3 geriatric impairments (compared with none) for the outcome of ADL disability were 2.12 (95% CI 1.63–2.75), 4.25 (3.30–5.48), and 7.87 6.10–10.17), respectively, and for having 1, 2, and ≥ 3 chronic diseases were 1.75 (1.41–2.19), 2.45 (1.95–3.07), and 3.26 (2.53–4.19), respectively. Similarly, the hazard ratios of having 1, 2, and ≥ 3 impairments for the outcome of mobility disability were 1.48 (1.27–1.73), 2.08 (1.77–2.45), and 3.70 (3.09–4.42), and for having 1, 2, and ≥ 3 diseases were 2.06 (1.76–2.40), 2.80 (2.36–3.31), and 4.20 (3.44–5.14). Conclusion As compared with number of chronic diseases, the number of geriatric impairments was more strongly associated with subsequent ADL disability, and nearly as strongly associated with the subsequent mobility disability. PMID:20863328

  18. Saliva stimulants and the oral health of geriatric patients.

    PubMed

    Mäkinen, K K; Pemberton, D; Cole, J; Mäkinen, P L; Chen, C Y; Lambert, P

    1995-07-01

    Root-surface caries (RSC) has been recognized as a specific and important dental disease. Significant advances have been made in the pathology and microbiology of RSC, and the need to standardize the guidelines for recording RSC data has been recognized. Researchers have emphasized the increasing impact RSC will have on the geriatric population, especially since the methods to treat and prevent this disease are limited. The purpose of this study was to investigate the possibility of limiting RSC in a Veterans Administration (VA) patient population, using polyol-containing saliva stimulants that were voluntarily consumed by residents of a VA Medical Center (VAMC) over a period of from six to 30 months. Another aim was to study the effect of this program on the gingival health of periodontal patients. PMID:7546130

  19. RISK FACTORS IN DELIRIOUS GERIATRIC GENERAL MEDICAL INPATIENTS

    PubMed Central

    Khurana, Paramjeet Singh; Sharma, P.S.V.N.; Avasthi, Ajit

    2002-01-01

    The present study was carried out on the hospitalized geriatric general medical patients with the aim to identify the possible risk factors associated with delirium in the elderly. The assessment of the patients was carried out using Mini Mental Status Examination (MMSE), Delirium Symptom Interview (DSI), Delirium Rating Scale (DRS) and ICD-10 Diagnostic Criteria for Research for delirium Details of medical records were collected. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. Pre-existing cognitive deficits, neurological illnesses, urinary tract infections, visual impairment, hearing impairment, current proteinuria, leukocytosis, raised blood ammonia, hyponatremia and potassium level disturbances were the risk factors identified. PMID:21206582

  20. PREVALENCE OF DELIRIUM IN GERIATRIC HOSPITALIZED GENERAL MEDICAL POPULATION

    PubMed Central

    Khurana, Paramjeet Singh; Sharma, P.S.V.N.; Avasthi, Ajit

    2002-01-01

    The present study was carried out on the hospitalised geriatric general medical patients. The assessment of the patients was carried out within 24 hours of admission and on every fourth day thereafter using Mini Mental Status Examination (MMSE), Confusion Assessment Method (CAM), Delirium Symptom Interview (DSI) and ICD-10-Diagnostic Criteria of Research for delirium. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. 19% was the rate of ‘prevalent’ delirium and 8% was the rate of ‘incident’ delirium. It is observed that the CAM is a useful screening method with high sensitivity for diagnosis of delirium at the bedside. PMID:21206880