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A multidisciplinary clerkship was developed as a required course for third year medical students. The drawbacks of traditional medical education as it applies to the field of geriatrics are reviewed. The development of a week-long clerkship in geriatricmedicine is described with special focus on a multidisciplinary geriatric home assessment required of all students. Evaluation of the clerkship and the
Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatricmedicine and the care of older adult patients. This article describes a fourth-year geriatricclerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatricmedicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatricmedicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatricclerkship and voted this clerkship "the most outstanding clinical course" at the medical school. PMID:20398156
Golden, Adam G; van Zuilen, Maria H; Mintzer, Michael J; Issenberg, S Barry; Silverman, Michael A; Roos, Bernard A
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
This article describes medical students' evaluation of a geriatricclerkship in postacute rehabilitative care settings. This was a cross-sectional study of fourth-year medical students who completed a mandatory 2-week rotation at a postacute care facility. Students were provided with three instructional methods: Web-based interactive learning modules; small-group sessions with geriatric faculty; and Geriatric Interdisciplinary Care Summary (GICS), a grid that students used to formulate comprehensive interdisciplinary care plans for their own patients. After the rotation, students evaluated the overall clerkship, patient care activities, and usefulness of the three instructional methods using a 5-point Likert scale (1=poor to 5=excellent) and listed their area of future specialty. Of 156 students who completed the rotation, 117 (75%) completed the evaluation. Thirty (26%) chose specialties providing chronic disease management such as family, internal medicine, and psychiatry; 34 (29%) chose specialties providing primarily procedural services such as surgery, radiology, anesthesiology, pathology, and radiation oncology. Students rated the usefulness of the GICS as good to very good (mean+/-standard deviation 3.3+/-1.0). Similarly, they rated overall clerkship as good to excellent (3.8+/-1.0). Analysis of variance revealed no significant group difference in any of the responses from students with the overall clerkship (F(112, 4)=1.7, P=.20). Students rated the geriatricclerkship favorably and found the multimodal instruction to be useful. Even for students whose career choice was not primary care, geriatrics was a good model for interdisciplinary care training and could serve as a model for other disciplines. PMID:19682134
Bautista, Miho K; Meuleman, John R; Shorr, Ron I; Beyth, Rebecca J
Objective Feedback is a technique used in medical education to help develop and improve clinical skills. A comprehensive review article specifically intended for the emergency medicine (EM) educator is lacking, and it is the intent of this article to provide the reader with an in-depth, up-to-date, and evidence-based review of feedback in the context of the EM clerkship. Methods The review article is organized in a progressive manner, beginning with the definition of feedback, the importance of feedback in medical education, the obstacles limiting the effective delivery of feedback, and the techniques to overcome these obstacles then follows. The article concludes with practical recommendations to implement feedback in the EM clerkship. To advance the literature on feedback, the concept of receiving feedback is introduced. Results The published literature regarding feedback is limited but generally supportive of its importance and effectiveness. Obstacles in the way of feedback include time constraints, lack of direct observation, and fear of negative emotional responses from students. Feedback should be timely, expected, focused, based on first-hand data, and limited to behaviors that are remediable. Faculty development and course structure can improve feedback in the EM clerkship. Teaching students to receive feedback is a novel educational technique that can improve the feedback process. Conclusion Feedback is an important educational technique necessary to improve clinical skills. Feedback can be delivered effectively in the EM clerkship.
Bernard, Aaron W; Kman, Nicholas E; Khandelwal, Sorabh
|The DWR Department of GeriatricMedicine at OUHSC and the OKC VA Medical Center began a mandatory third-year geriatricmedicineclerkship 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…
|Experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships was compared with the experience on a family medicineclerkship. The family medicineclerkship offered the most experience with circulatory, respiratory, digestive, neurological, musculoskeletal, and skin problems and with…
Background and Objectives: Despite the increased prominence of family medicineclerkships in required third- and fourth-year clinical rotations in US allopathic medical schools, the content of these clerkships varies markedly among institutions, and there is little in the literature concerning the current or desired content of family medicineclerkships. This study explores the didactic content of a national sample of
The purpose of the project was to develop a Manual of Clinical Preventive Medicine which would provide medical students, preceptors, and clerkship faculty with a reference tool to teach and learn practical preventive medicine skills and knowledge during a...
BACKGROUND: In 1995, the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM) developed\\u000a and disseminated a new model curriculum for the medicine core clerkship that was designed to enhance learning of generalist\\u000a competencies and increase interest in general internal medicine.\\u000a \\u000a \\u000a OBJECTIVE: To evaluate the dissemination and use of the resulting SGIM\\/CDIM Core MedicineClerkship
Robert S. Jablonover; Dionne J. Blackman; Eric B. Bass; Gail Morrison; Allan H. Goroll
Purpose: The purpose of this study was to determine how well published expectations are being met for internal medicine (IM) clerkship directors (CDs).Method: In 2005, the Clerkship Directors in Internal Medicine (CDIM) surveyed its institutional members. One section addressed expectations, in terms of requirements and resources, of and for CDs. Survey questions were categorical (yes, no, or unsure) addressing the
Steven J. Durning; Klara K. Papp; Louis N. Pangaro; Paul Hemmer
|A survey of 314 medical students before and after a required third-year internal medicineclerkship 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)|
|The importance of incorporating Professional Standards Review Organizations (PSRO) and related material in the medical curriculum during a phase of the one-month clerkship in community and family medicine is discussed. (Author/PG)|
Although Emergency Medicine (EM) is an integral part of undergraduate medical curriculum in many countries, it has not been included formally in the MBBS curriculum in Pakistan. Medical graduates are supposed to be able to handle common as well as life threatening emergencies but little has been done to ensure the process to achieve this competence. The development of an undergraduate EM curriculum is important but challenging task. Implementation of standard curriculum will ensure that medical graduates have gained competence in assessing and managing acutely ill patients and dealing with common emergencies. This paper shares the features of an undergraduate EM clerkship which can be used as a template by other medical institutions. PMID:22125992
Mehmood, Amber; Baqir, Syed Muhammad; Shahid, Muhammad; Razzak, Junaid Abdul
Background: Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). Description: During the first 18 weeks of
Stephen C. Aronoff; Barry Evans; David Fleece; Paul Lyons; Lawrence Kaplan; Roberto Rojas
A study investigated the effect of participation in an intensive internal medicine conference series during a third-year medicineclerkship (n=173 students) on medical licensing examination scores and compared this with scores in surgery and pediatrics and scores of 466 students not participating in the conference. Better test performance on the…
We provided a laboratory test program for the personal digital assistant (PDA) to a cohort of third year medical students during their internal medicineclerkship. At the end of each rotation, students were interviewed about their experience with the program, and tracking information was downloaded from their PDAs. Students found the program helpful and easy to use, accessed it more often during patient care activities than as a study aid, and considered the program a better way to learn about laboratory tests than formal teaching sessions. The program was accessed an average of 4 or 5 times per week, although individual use was highly variable. There was no relationship between end-of-clerkship examination scores and the number of tests that were accessed. The PDA program is an effective way to introduce laboratory facts and concepts into an internal medicineclerkship. PMID:18285267
Schreiber, William E; Busser, James R; Huebsch, Suzanna
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 geriatricmedicine content in the U.K. generic curriculum, reviewing this in…
|Recent studies by the Institute of Medicine, part of the National Academy of Sciences, and the Rand Corporation have suggested that most physicians in the United States are inadequately trained to cope with the care of the elderly, in spite of the fact that over 11% of the population is over age 65. At present, nearly 30% of all health care…
The aging of the U.S. population poses one of the greatest future challenges for family medicine and internal medicine residency training. One important barrier to providing quality education and training in geriatricmedicine to residents is a serious and growing shortage of practicing geriatricians and geriatrics faculty. The Accreditation Council for Graduate Medical Education currently accredits 45 family medicine-based and 107 internal medicine-based geriatricmedicine fellowships in the United States. There are 13 American Osteopathic Association-certified geriatricmedicine fellowship programs. In this article, the authors examine the rationale for the development of additional geriatricmedicine fellowship programs and offer some practical suggestions and pointers for those interested in developing their own geriatricmedicine fellowships. The authors write from the perspective of their own recent experiences with the development and accreditation of a family medicine residency-affiliated fellowship in geriatrics. Other residencies may find this article useful in determining the feasibility of developing a geriatricmedicine fellowship for their programs and communities and will find practical guidance for beginning the process. PMID:21824121
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 GeriatricMedicine Fellowship training include cultural competency training. Through a needs assessment survey of the GeriatricMedicine Fellows, a curriculum
The mission of Clerkship Directors in Internal Medicine (CDIM) is to promote excellence in medical student internal medicine education. The organization represents course directors, site directors, and program administrators. CDIM is a member of the Alliance for Academic Internal Medicine, a consortium of five academically focused specialty organizations representing departments of internal medicine, at medical schools and teaching hospitals in
Academic geriatricmedicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full-time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatricsclerkship, and 87% (n = 83) had an elective geriatricclerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans. PMID:22861051
Bragg, Elizabeth J; Warshaw, Gregg A; Meganathan, Karthikeyan; Brewer, David E
An EBM Seminar and POEM® project was developed to teach evidence-based medicine in a family medicineclerkship. 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
Objective:To improve medical students’ ability and willingness to obtain occupational histories from their patients.\\u000a \\u000a Participants:General medicine faculty and internal medicine teaching residents, who participated as instructors, and medical students during\\u000a their required internal medicineclerkships.\\u000a \\u000a \\u000a \\u000a Setting:The primary teaching hospitals of two medical schools.\\u000a \\u000a \\u000a \\u000a Design:During alternate months, students participated in problem-based sessions that included occupational health objectives (intervention)\\u000a or attended the
Rosemary K. Sokas; Deborah Diserens; Mary Anne Johnston
The increased number of required family medicineclerkships has created the need for more qualified faculty to serve as preceptors. One solution to the faculty shortage is to use volunteer faculty practicing in the private setting. This article describes how volunteer faculty at one institution were selected and trained and compares the performance of volunteer and full?time faculty using several
L. Peter Schwiebert; Christian N. Ramsey Jr; Alan Davis
This article reports on the analysis of content from focus groups held to assess medical residents' attitudes about geriatric health care. Internal medicine residents volunteered to participate in a curriculum discussion. Discussions were guided by a moderator to elicit attitudes toward older people and caring for them and were recorded via audiotape, transcribed, and qualitatively analyzed. Residents distinguished “old” from
Peer-mediated learning is an effective educational strategy that is rarely used during clinical training for medical students. We developed a peer-mediated learning conference, Student-Faculty Rounds (SFR), for the ambulatory component of a medicineclerkship. Designed to broaden students' exposure to common medical problems and provide practice in small-group teaching, the 30-minute conference is conducted by each student once during their clerkship. Students choose their topics and instructional formats, but they are advised to supply written learning objectives and employ interactive, problem solving opportunities. We analysed evaluations written by 280 students and 17 faculty supervisors during 1998-2001. Students presented over 150 topics. The most common were hypercholesterolemia, diabetes, headache, smoking cessation, hypertension management, and cancer screening (each presented in 3-4% of rounds). On a scale of 10 (outstanding) to 0 (lost cause), students gave SFR a score of 9.2 (95% confidence interval 9.0-9.3). In written comments, students indicated that topics were relevant and that peers provided instruction at an appropriate level of complexity, but that quality was variable. Faculty supervisors reported that 35% of students did not provide written learning objectives and 35% chose topics too broad for a 30-minute conference. SFR is a popular conference that accomplishes its educational objectives. It recognizes students' ability to educate themselves, and introduces variability and challenge into the classroom curriculum. Adequate faculty guidance is needed to assure students design conferences for maximum educational effectiveness. PMID:16019334
Kernan, Walter N; Quagliarello, Vincent; Green, Michael L
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
Kelley, Amy S; Back, Anthony L; Arnold, Robert M; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; Smith, Cardinale B; O'Neill, Lynn B
|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 GeriatricMedicine Fellowship training include cultural competency training.…
Objective To determine the prevalence and influence of specific attending teaching practices on student evaluations of the quality of attendings' teaching in the inpatient component of Internal Medicineclerkships. Design Nationwide survey using a simple random sample. Setting One hundred and twenty-one allopathic 4-year medical schools in the United States. Participants A total of 2,250 fourth-year medical students. Measurements and Main Results In the spring of 2002, student satisfaction with the overall quality of teaching by attendings in the inpatient component of Internal Medicineclerkships was measured on a 5-point scale from very satisfied to very dissatisfied (survey response rate, 68.3%). Logistic regression was used to determine the association of specific teaching practices with student evaluations of the quality of their attendings' teaching. Attending physicians' teaching practices such as engaging students in substantive discussions (odds ratio (OR)=3.0), giving spontaneous talks and prepared presentations (OR=1.6 and 1.8), and seeing new patients with the team (OR=1.2) were strongly associated with higher student satisfaction, whereas seeming rushed and eager to finish rounds was associated with lower satisfaction (OR=0.6). Conclusion Findings suggest that student satisfaction with attendings' teaching is high overall but there is room for improvement. Specific teaching behaviors used by attendings affect student satisfaction. These specific behaviors could be taught and modified for use by attendings and clerkship directors to enhance student experiences during clerkships.
Guarino, Cassandra M; Ko, Clifford Y; Baker, Laurence C; Klein, David J; Quiter, Elaine S; Escarce, Jose J
Handheld electronic patient encounter logs offer opportunities to understand and enhance medical students' clinical experiences. Before using the data, the reliability of log entries needs to be verified. We assessed the sensitivity and specificity of handheld patient encounter logs by comparing documented entries with reliable external data sources. During an Emergency Medicineclerkship, medical students voluntarily recorded their patients' diagnoses in an Electronic Student Encounter Log (E-SEL) on handheld computers. We used patient demographics to match anonymous log entries with medical charts. Most students recorded 60% or more of their patient encounters and on average 60% of their patients' medical problems in the log. The false positive rate was 26% for patient encounters and 19% for patient problems. In general, students recorded more diagnoses in more detail than was available in the patient's ED chart. Improvements in the log's interface and documentation incentives should enhance the log's accuracy and utility.
Lee, Jennifer S.; Sineff, Sanford S.; Sumner, Walton
U.S. academic medical centers are providing many geriatricmedicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu). PMID:16686884
Warshaw, Gregg A; Bragg, Elizabeth J; Freyberg, Ron W
Occupational history is fundamental for the evaluation of possible workplace influences on health. We reviewed 2,922 initial history-and-physical reports from 137 third-year medical students to examine occupational history collection. Overall reporting frequencies were recorded as the following: industry, 55.8%; occupation, 70.0%; specific occupational exposure, 8.4%; smoking status, 91.4%. Patients younger than 40 years of age and women were significantly less likely than other older patients and men to have notations of occupation and industry. Surgery students were less likely than internal medicine students to collect data for industry (41.6% vs 66.6%, P < 0.001), occupation (57.4% vs 79.7%, P < 0.001), and smoking (88.1% vs 94.0%, P < 0.001). The highest frequencies of notation were those for circulatory and respiratory conditions. No significant differences were noted for student gender, academic quarter, or week of clerkship. Clinical occupational medicine teaching should emphasize the need to collect occupational information from all patients, including women and young persons. PMID:9729750
The vast amount of clinical information available today and the difficulties that clinicians have in applying this information\\u000a have given rise to interest in evidence-based medicine. An additional impetus for the development of the evidencebased medicine\\u000a movement has been the increasing recognition that much of medical practice is not evidence-based. This article presents a\\u000a brief overview of the principles of
|Focuses on the supports and impediments inherent in the provision of geriatric medical care by family physicians. Addresses providing a good educational program for medical students and residents who will be caring for the elderly and developing uniform access to quality care for the elderly, the community, and community institutions.…
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
In response to calls for medical education reform we designed and implemented a new Longitudinal Ambulatory Clerkship (LAC) at the Johns Hopkins University School of Medicine. The LAC provides first-year medical students with their initial exposure to clinical medicine during a 12-month experience consisting of weekly clinic sessions with a practicing physician-mentor (preceptor) and longitudinal experience with a population of patients. The LAC allows students to experience firsthand many of the personal, professional, and organizational issues that impact the practice of medicine. This paper reviews the rationale, development, and challenges during implementation of this clerkship.
Objectives To create user-friendly search filters with high sensitivity, specificity, and precision to identify articles on geriatricmedicine in Medline. Design A diagnostic test assessment framework was used. A reference set of 2255 articles was created by hand-searching 22 biomedical journals in Medline, and each article was labeled as ‘relevant’, ‘not relevant’, or ‘possibly relevant’ for geriatricmedicine. From the relevant articles, search terms were identified to compile different search strategies. The articles retrieved by the various search strategies were compared with articles from the reference set as the index test to create the search filters. Measures Sensitivity, specificity, precision, accuracy, and number-needed-to-read (NNR) were calculated by comparing the results retrieved by the different search strategies with the reference set. Results The most sensitive search filter had a sensitivity of 94.8%, a specificity of 88.7%, a precision of 73.0%, and an accuracy of 90.2%. It had an NNR of 1.37. The most specific search filter had a specificity of 96.6%, a sensitivity of 69.1%, a precision of 86.6%, and an accuracy of 89.9%. It had an NNR of 1.15. Conclusion These geriatric search filters simplify searching for relevant literature and therefore contribute to better evidence-based practice. The filters are useful to both the clinician who wants to find a quick answer to a clinical question and the researcher who wants to find as many relevant articles as possible without retrieving too many irrelevant articles.
van de Glind, Esther M M; van Munster, Barbara C; Spijker, Rene; Scholten, Rob J P M
Summarizes the initial results of the regional geriatricmedicine 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 geriatricmedicine education received by family practice residents. (EV)
|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 geriatricmedicine. The participants were first-year medical students (n = 137) who joined the Senior Teacher Education Partnership (STEP) program that…
Lu, Wei-Hsin; Hoffman, Kimberly G.; Hosokawa, Michael C.; Gray, M. Peggy; Zweig, Steven C.
|A total of 8 geriatricmedicine 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…
Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.
|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)|
|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 medicineclerkship from 2003 to 2007…
Abstract Objective To identify factors that help predict success for international medical graduates (IMGs) who train in Canadian residency programs and pass the Canadian certification examinations. Design A retrospective analysis of 58 variables in the files of IMGs who applied to the Collège des médecins du Québec between 2000 and 2008. Setting Quebec. Participants Eight hundred ten IMGs who applied to the Collège des médecins du Québec through either the “equivalency pathway” (ie, starting training at a residency level) or the “clerkship pathway” (ie, relearning at the level of a medical student in the last 2 years of the MD diploma). Main outcome measures Success factors in achieving certification. Data were analyzed using descriptive statistics and ANOVA (analysis of variance). Results International medical graduates who chose the “clerkship pathway” had greater success on certification examinations than those who started at the residency level did. Conclusion There are several factors that influence IMGs’ success on certification examinations, including integration issues, the acquisition of clinical decision-making skills, and the varied educational backgrounds. These factors perhaps can be better addressed by a regular clerkship pathway, in which IMGs benefit from learner-centred teaching and have more time for reflection on and understanding of the North American approach to medical education. The clerkship pathway is a useful strategy for assuring the integration of IMGs in the North American health care system. A 2-year relearning period in medical school at a clinical clerkship level deserves careful consideration.
|The Duke University School of Medicine has a unique curriculum in which students complete basic sciences in year 1 and clinical clerkships in year 2, making way for an entire year of independent study in year 3. Into this compact curriculum, education in geriatrics has been successfully introduced through focused exercises and activities…
Long term care facilities are important sites of care for elderly adults. Despite a growing need and interest in medical direction in nursing homes, there have been limited educational opportunities in this area for geriatricmedicine fellows. This article describes a novel medical director's curriculum for first-year geriatricmedicine fellows to prepare them for the role of nursing home medical director. This novel curriculum has been integrated into the Department of GeriatricMedicine's Fellowship training program at the John A. Burns School of Medicine, University of Hawaii. The curriculum consists of seven seminars that have been integrated into the didactic sessions during the first year of fellowship. Core content areas include: (1) roles and responsibilities of the medical director, (2) infection control, (3) physician documentation, (4) federal regulations and state surveys, (5) quality improvement, (6) culture change in nursing homes, and (7) transitions in care. All topics were discussed using the framework described by the American Medical Directors Association's position statement on the roles and responsibilities of the nursing home medical director. To our knowledge, this is the first curriculum in the medical literature that is designed to prepare geriatricmedicine fellows for roles as medical directors in nursing homes. PMID:23168110
|Electronic portfolios (ePortfolios) can be useful for evaluating and documenting mastery of competencies. We investigated geriatricmedicine 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…
Ruiz, Jorge G.; Qadri, Syeda S.; Karides, Marina; Castillo, Carmen; Milanez, Marcos; Roos, Bernard A.
Electronic portfolios (ePortfolios) can be useful for evaluating and documenting mastery of competencies. We investigated geriatricmedicine 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…
Ruiz, Jorge G.; Qadri, Syeda S.; Karides, Marina; Castillo, Carmen; Milanez, Marcos; Roos, Bernard A.
Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices
Meenakshy K. Aiyer; T. Robert Vu; Cynthia Ledford; Melissa Fischer; Steven J. Durning
The specialism of geriatricmedicine has developed considerably in the last half of the twentieth century. In Great Britain it has emerged from its sombre beginnings in Victorian poor law institutions to become one of the largest specialities in medicine encompassing a wide range of disciplines and interests. More recently, there has been a parallel development in "intermediate care" a sweeping phrase that encompasses a wide diversity of practices in a plethora of venues. Although there is considerable attraction in minimising the duration of hospital stay by older people, there is a real risk of intermediate care being used as a euphemism for indeterminate neglect. For older people to benefit from appropriate treatment and care, the lessons learnt by earlier generations of geriatricians, and supported by the international evidence base should not be disregarded. Elderly people need a full multi-disciplinary assessment (comprehensive geriatric assessment) and continued involvement of skilled and trained personnel in their continuing care (geriatric evaluation and management). The recommendations of the British Geriatrics Society on intermediate care are commended and should be adhered to by all planners and providers of intermediate care. There is considerable logic in developing ways in which the two developments can be integrated to build upon the best features of both. PMID:11511484
Long term care deserves focused attention within a geriatricmedicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy aspects of their future roles. This report describes the curriculum development and program evaluation of an advanced course in long term care for geriatricmedicine fellows and other graduate/post-graduate health professionals at Duke University. Course evaluation had 4 goals: (1) to determine how well the learning objectives were met; (2) to evaluate individual components of the course to improve subsequent offerings; (3) to determine whether additional topics needed to be added; and (4) to evaluate the effectiveness of the discussion forum component of the course. Learner self-efficacy improved within all competency areas but especially those of practice-based learning and system-based practice. Evaluation results led to curriculum revision that has maintained course relevance and sustained it within the larger geriatrics fellowship curriculum. Components of this course can be easily adapted to other curricular settings for fellows and residents. PMID:23623522
White, Heidi K; Buhr, Gwendolen; McConnell, Eleanor; Sullivan, Robert J; Twersky, Jack; Colon-Emeric, Cathleen; Heflin, Mitchell; Cutson, Toni M; Logan, William; Lyles, Kenneth; Pinheiro, Sandro O
It is commonly believed thatgeriatric medicine generates a distinctive setof ethical problems. Implicated are such issuesas resource allocation, competence and consent,advance directives, medical futility anddeliberate death. It is also argued that itwould be unjust to allow the elderly to competewith younger populations for expensive andscarce health care resources because theelderly “have already lived,” and that treatingthem the same as these
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…
|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…
|Shay, Simpson, and Biernat describe geriatric dentistry training that included mentorship and shared experiences with physician trainees. Cohen and Lyles describe a fellowship program in which physicians care for older patients in unique settings and conduct research projects. (SK)|
Shay, Simpson, and Biernat describe geriatric dentistry training that included mentorship and shared experiences with physician trainees. Cohen and Lyles describe a fellowship program in which physicians care for older patients in unique settings and conduct research projects. (SK)
PURPOSE To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge.\\u000a \\u000a \\u000a \\u000a METHODS Using a mixed methods, prospective, controlled trial, volunteer control group students (n?=?17) at two sites and intervention\\u000a group students (n?=?16) at two different sites within the same internal medicineclerkship were given Internet and CDROM-based\\u000a geriatric self-study materials. Intervention group students
Gerald D. Denton; Rechell Rodriguez; Paul A. Hemmer; Justin Harder; Patricia Short; Janice L. Hanson
|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…
Soltys, Stephen M.; Pary, Robert J.; Robinson, Stephen W.; Markwell, Stephen J.
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 geriatricmedicine 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
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 geriatricmedicine 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.
A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas.
Bang, Ki Moon; Greene, E. Josephine; Williams, Henry W.; Leath, Brenda A.; Matthews, Ruth
Background: Consistent and effective implementation of clinical clerkship objectives remains elusive. Using the behavioral principles\\u000a of self assessment, active learning and learner differences, we designed an objectives checklist to ensure that all students\\u000a mastered a core body of internal medicine (IM) knowledge and to facilitate self-directed learning. Methods: We developed a 54-item learning objectives checklist card in the IM clerkship.
Karen E. Hauer; Arianne Teherani; Jeff Wiese; Cynthia L. Fenton
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…
Li, Ina; Arenson, Christine; Warshaw, Gregg; Bragg, Elizabeth; Shaull, Ruth; Counsell, Steven R.
|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…
Li, Ina; Arenson, Christine; Warshaw, Gregg; Bragg, Elizabeth; Shaull, Ruth; Counsell, Steven R.
Home visits have a long history in geriatrics. In this narrative review, the literature on home visits performed by specialists in geriatricmedicine (or psychiatry) and/or specialized programs in geriatricmedicine (or psychiatry) published between January 1988 and December 2008 was examined. The papers reviewed were few and inconsistent in their message. The lessons that can be derived from them are limited. Draft recommendations about the role of home visiting by specialized geriatric programs in Canada are presented.
The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM),\\u000a American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine\\u000a (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings.\\u000a The following summarized principles were established: 1.) Accountability; 2)
Vincenza Snow; Dennis Beck; Tina Budnitz; Doriane C. Miller; Jane Potter; Robert L. Wears; Kevin B. Weiss; Mark V. Williams
This paper describes development, implementation, and evaluation strategies of a longitudinal geriatric curriculum, the Senior Mentor Program (SMP). The rationale for exposing undergraduate medical students to healthy, community-dwelling older adults is to use the relationship and activities as vehicles for improving knowledge of aging and providing students experience with aging as a stage and process. The University of South Carolina School of Medicine's major aim in geriatrics is to prepare students to become skilled physicians in care of older adults. The SMP is embedded into the curriculum. The program introduced medical students to healthy older adults, presented selected health care issues in this population, integrated material early in the curriculum, acquainted students with longitudinal patient care, and introduced students to older adults' living arrangements. The SMP is an effective means of infusing geriatric content into the medical school curriculum and positively affects mentors' and students' attitudes toward each other. This has implications for medical and professional schools, such as nursing, social work, and physical therapy. PMID:17023380
Roberts, Ellen; Richeson, Nancy; Thornhill, Joshua T; Corwin, Sara J; Eleazer, G Paul
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…
Rationale and ObjectivesThe purpose of this study was to investigate the ability of medical students who had already completed medicine and surgery clerkships to identify life-threatening abnormalities on conventional chest radiographs.
Jac D. Scheiner; Richard B. Noto; Kathleen M. McCarten
Training in GeriatricMedicine has become increasingly important in the education of family physicians. This paper describes the experience of a community-based Family Medicine residency in developing an ambulatory Geriatric Evaluation Unit (GEU) as part of a comprehensive geriatric curriculum. The experience demonstrates the value of a multidisciplinary team approach, systematic development and integration of additional education activities as effective techniques for training family physicians and ancillary health care providers. PMID:2583541
|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…
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…
Modern medicine, which is evidence-based and overly scientific, has forgotten its artistic component, which is very important for surgery in general and for geriatric surgery in particular. The surgeon treating an old patient must be a politician more than a technician, more an artist than a scientist. Like Leonardo da Vinci, he or she must use scientific knowledge with intelligence and sensitivity, transforming the elderly patient's last days of life into a beautiful and harmonious painting and not into something like an atomic power station which, while no doubt useful, is deprived of beauty and sometimes very dangerous. PMID:16669139
The challenge of geriatricmedicine in an era of limited resources is addressed. Focus is on containing the costs of health care in several neglected areas of geriatrics: stroke, long-term care, patient and family counseling, and death. (JMD)
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 on Aging, curriculum committee and Associate\\/Assistant Deans of Education, and faculty from
Debra A. Newell; Mukaila Raji; Steven Lieberman; Robert E. Beach
The third-year clerkship at one college of medicine was modified to reflect an emphasis on adult learning principles and life-long learning habits. Problem-based learning was selected as the educational method, and the development of a cognitive knowledge base, clinical problem-solving skills, and appropriate clinical skills was stressed. At a yearly faculty education retreat, strengths and weaknesses of the clerkship were discussed. As a result of this meeting, several changes were made in the clerkship, including additional stress on students' usage of the medical library and computerized databases, a tutor development program, the addition of expert resource sessions, and more emphasis on students' development of clinical skills through a preceptor program. A comprehensive evaluation program designed to support the educational goals of the clerkship is in place. The major challenge of the program remains the proper synchronization of curricular, clinical, and student self-study activities essential for an ideal learning experience. PMID:8246717
Jones, R O; Donnelly, M B; Nash, P P; Young, B; Schwartz, R W
This article sits at the nexus between two bodies of work, gerontology and migration research, both of which have theorised the body as the locus of stigma. Gerontologists, while acknowledging the significance of perceptions of the ageing body for engagement and participation in society, have often evaded direct engagement with physical and medical understandings of older bodies. In parallel, research which focuses on migration, race and the body has focused on how the migrant body is stigmatised both because of its somatic markers and because of the status of the frail older people whom they tend. Drawing on oral history interviews with UK born and South Asian overseas-trained geriatricians, the article argues that the two bodies, which are usually seen in negative ways, came together in meaningful ways in the development of the specialty of geriatricmedicine. Thinking of the body as an assemblage with many elements, some of which are stigmatised but which can nevertheless be recuperated, helps us to think beyond stigma in the context of body work. PMID:21241337
hy begin a series dedicated to geriatricmedicine in Hospital Physician, and why now? Over the next 50 years, a profound change in the demographics of our soci- ety will necessitate that our health care system and, in particular, the primary provider prepare for the unique health care needs of the older adult. 1 As the baby boomers age, the
|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).…
Rosenthal, Renate H.; Levine, Ruth E.; Carlson, David L.; Clegg, Kathleen A.; Crosby, Ross D.
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
For more than half a century, scientific research has documented widespread avoidance and even denial of aging. Though nothing new, aversive reactions to the elderly are not only unfortunate but dangerous today, as increasing life expectancy and consequent demand for specialized geriatric medical care vastly outpace the supply of qualified clinicians equipped to provide it. This discrepancy has led to a crisis that is not easily resolved. At the same time, geriatrics reports the highest level of physician satisfaction among medical specialties. How can this apparent disconnect be explained, and what can be done about it? Citing evidence from medicine and other health care disciplines, the authors address these questions by emphasizing the role of aging-related attitudes, a complex but theoretically modifiable construct. Successful educational interventions are described, including the authors' experience at the helm of a monthlong geriatricsclerkship for fourth-year medical students. Novel suggestions are provided to combat the daunting challenges to achieving a workforce that is sufficient both in number and training to effectively meet the needs of the fastest-growing segment of the U.S. population. As patients continue to age across most medical specialties, the importance of geriatric curricula, particularly those sensitizing learners to the need for a systems-based, biopsychosocial (i.e., interdisciplinary) model of care, cannot be overemphasized. Such training, it is argued, should be a standard component of medical education, and future research should focus on identifying specific curricular content and teaching methods that most effectively achieve this end. PMID:24072114
Bensadon, Benjamin A; Teasdale, Thomas A; Odenheimer, Germaine L
Objective: Taking a psychiatric history is a key educational objective in the psychiatry clerkship. Medical students arrive on psychiatry clerkships unprepared for the unique challenges of psychiatric interviewing. This paper describes an interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group…
|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)|
AIM To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students’ recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings. PROGRAM AND SETTING This required curriculum was implemented within a 4-week family medicineclerkship (n?=?188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of a written assignment in response to structured questions was followed by in-class discussion in week 4. PROGRAM EVALUATION Outcomes were students’ session evaluations, thematic analysis of student responses, and analysis of faculty facilitators’ reflections about discussion sessions. Students’ cultural knowledge about their patients’ health beliefs around diabetes was assessed using multiple choice questions at the beginning and end of the clerkship. RESULTS One hundred percent of students submitted narratives. Student evaluations demonstrated high acceptance, appreciation of sessions and faculty. Analyses of written assignments and in-class discussions identified recurring themes. Students achieved greater synthesis and more nuanced understanding of cross-cultural encounters after discussion. Self-rating of confidence in addressing cultural issues after the curriculum was high at 3.17?±?SD 0.57 (1–4). Cultural knowledge scores improved significantly. Core components for success were clerkship director support, required participation, experienced faculty facilitators without evaluative roles, a structured assignment and formal forum for trigger question discussion DISCUSSION Written reflection followed by facilitated peer discussion adds value to simple ‘exposure’ to cross-cultural clinical experiences for medical students.
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…
Newell, Debra A.; Raji, Mukaila; Lieberman, Steven; Beach, Robert E.
|Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development,…
Newell, Debra A.; Raji, Mukaila; Lieberman, Steven; Beach, Robert E.
|This paper describes development, implementation, and evaluation strategies of a longitudinal geriatric curriculum, the Senior Mentor Program (SMP). The rationale for exposing undergraduate medical students to healthy, community-dwelling older adults is to use the relationship and activities as vehicles for improving knowledge of aging and…
Roberts, Ellen; Richeson, Nancy A.; Thornhill, Joshua T., IV; Corwin, Sara J.; Eleazer, G. Paul
The author describes a 1-month rotation in geriatricmedicine for family practice residents. Residents work at a geriatric center with day patients, residents in a home for the aged, and acute and chronic-care hospital patients, under the supervision of geriatricians, family physicians, and specialists. They then work in the office of a family physician or in an outpatient miniclinic within a senior citizen housing complex. All residents reported increased comfort with elderly patients, and many have chosen to include geriatrics in their practices. Imagesp2039-ap2041-a
Background The article discusses the position of elderly patients in the context of medical intervention. The phenomenon of a “greying” population has changed the attitude towards the elderly but common observations prove that the quality of geriatric care is still unsatisfactory. This is a comparative study of personality among people at different ages, designed to improve specialists’ understanding of ageing. The results are discussed in relation to the elderly patient-centered paradigm to counterbalance ageist practices. Material/Methods This study involved 164 persons in early and late adulthood. Among the old, there were the young old (ages 65–74) and the older old (ages 75+). All participants were asked to fill-out the NEO-FFI . Results The results demonstrate age-related differences in personality. In late adulthood, in comparison to early adulthood, there is decreased openness to new experiences. Two traits – agreeableness and conscientiousness – increase significantly. Age did not differentiate significantly the level of neuroticism or extraversion. The results of cluster analyses show differences in taxonomies of personality traits at different periods of life. Conclusions The results challenge the stereotypes that present older people as neurotic and aggressive. Age did not significantly influence the level of neuroticism or extraversion. In general, the obtained results prove that the ageist assumption that geriatric patients are troublesome is false. This article builds support for effective change in geriatric professional practices and improvement in elderly patients’ quality of life.
AIM To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students’\\u000a recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings.\\u000a \\u000a \\u000a \\u000a \\u000a PROGRAM AND SETTING This required curriculum was implemented within a 4-week family medicineclerkship (n?=?188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of
Desiree Lie; Johanna Shapiro; Felicia Cohn; Wadie Najm
The community-based internist and geriatric primary care physicians (PCPs) or medical doctors (MDs) have long been the most prevalent providers of primary care to populations who have chronic illness and\\/or are elderly in the United States. This article addresses the strategies for disease management (DM) that physicians in nonmature health care markets are utilizing to address unmet needs and suggestions
An examination of an open-book testing approach in a family medicineclerkship seeks to determine whether this method more closely mirrors the discipline of family medicine, where practitioners refer daily to written resource materials in order to make clinical decisions without compromising the learning and assessment process. Student scores on the multiple-choice test were analysed by year, by quarter and by site using ANOVA. Students in the experimental site were interviewed to determine preparation style, use of text during test, as well as attitudes toward open-book testing. Analysis of variance showed that the interaction of site and year was significant at p = 0.03. The mean score of 88.2 for Maine students in 2002 was significantly different from the other three mean scores. The desired qualitative outcomes of the intervention were confirmed: reducing the anxiety of students, wider reading of the textbook, knowing the structure of the textbook as a learning resource, and deeper understanding of concepts and principles rather than time spent on memorization. While the difference in scores did reach statistical significance, it is important to note that the difference in mean score was only four points on a 100-point scale. Given the percentage of the total grade represented by the test score, it is unlikely that this difference represents any real difference in grade for students in Maine compared with Vermont. The students appeared to approach the textbook and therefore, perhaps, the body of knowledge as a whole with the orientation of a generalist. The MMC Clerkship Director recommended the implementation of the open-book approach to the Family Practice clerkship at all sites and the University of Vermont Medical School accepted the proposal. This recommendation supports advising students on the preparation for an open-book test and on tactics for the best use of the textbook during the test. PMID:16147801
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)
|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,…
|Objective: To assist and inform the process of revising learning objectives for the psychiatry clerkship, a comprehensive review of the current state of learning objectives endorsed by national specialty organizations for core clinical clerkships was undertaken. Methods: National specialty organizations that have developed and endorsed clerkship…
At one time, the psychiatry of old age was believed to be “the darkest area of psychiatry.” The often confounding nature of\\u000a psychiatric disorder in the elderly is illustrated by the large number of terms used over the years to address the diversity\\u000a among geriatric psychiatric patients, including “late paraphrenia,” “vascular depression,” “pseudodementia,” and “masked depression.”\\u000a Many of these labels
Ethics is a fundamental part of geriatricmedicine. Ethical questions are important in all fields of medicine but in geriatrics they are of particular importance. This branch of medicine is concerned with the care and health problems of mostly very old people close to the end of life. They are physically, mentally and socially vulnerable, frail individuals with a high risk for progressive deficits in physical and cognitive functions and are thus progressively dependent on help and care. Decisions about medical interventions are easier when the patients concerned have an intact decisional capacity and is more complex and difficult when dealing with multimorbid, frequently cognitively impaired very old individuals. Ethics is about systematically asking the right questions. This process should be logically structured but questions may remain unanswered. It is about questioning prejudices and modes of action, it means explaining terminology, requesting the best facts possible, formulating definitions and helping to logically reflect on a problem. Good ethics begins with good facts, not with groundless assumptions. PMID:22915004
A sound clinical education should include the opportunity for medical students to engage in a spirited and informed discussion with faculty about the ethical challenges they will undoubtedly face. Unfortunately, in many medical schools today this goal is thwarted by many factors, including denial that a problem exists, relentless system overload, unprofessional behavior, breakdown in communication, and inertia. What is worse is that this problem is not new, and the fallout is not insignificant. Another potential contributing factor is burnout, which is well documented in a high percentage of medical students, residents, and faculty, and two of its most serious consequences are patient dissatisfaction and medical error.The authors draw on hundreds of student reflections on ethical dilemmas submitted during classroom exercises to examine persistent themes. They posit that classroom and didactic teaching is not enough to enable students to face ethical dilemmas. The authors call for a major culture change in medical education: "buy in" from top administration, especially the dean (and associate/assistant deans), chairs of all departments, and clerkship and residency training directors; the appointing of an ombudsperson and/or ethicist to oversee and resolve issues as they arise; instructional workshops and materials to enhance and impart skills for all teachers; remediation or retiring of errant faculty; and ongoing research and dialogue between and among medical centers about novel solutions. PMID:24072128
Provides a description and preliminary evaluation of the CyberDoc program at the MCP-Hanhemann School of Medicine of the Allegheny University of the Health Sciences (Pennsylvania). The program allows faculty to track students' progress at off-site clerkships and allowed students to access a variety of databases, electronic mail, and other…
Background With regard to the growing proportion of elderly multimorbid patients, a sound undergraduate geriatric education becomes more important. Therefore we included the execution and interpretation of a comprehensive geriatric assessment (CGA) into a mandatory two-week clerkship at a general practitioner's office. The present study examined the effect of a guide structuring the students’ considerations when interpreting a CGA on the quantity and accuracy of the documented findings and conclusions. Methods We compared random samples out of two cohorts of fourth-year medical students (interpreting the CGA with and without using the structured interpretation guide) completing their clerkship between April 2006 and March 2008 with regard to the content of the CGA interpretation and the grades the students achieved for their clerkship documentation, which were substantially determined by the quantity and accuracy of the documentation and interpretation of the CGA. Results The structured interpretation guide led to significantly more mentions of aspects that have to be considered in geriatric patient care and to a higher documentation rate of respective positive results. Furthermore, students who analysed the CGA by using the interpretation guide achieved significantly better grades. Conclusions An additional tool structuring medical students’ considerations when interpreting a CGA increases the quantity and the accuracy of the documented findings and conclusions. This may enhance the students’ learning gain.
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
Barbara Ogur; David Hirsh; Edward Krupat; David Bor
Background Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric\\u000a Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize\\u000a geriatric palliative care in Europe.\\u000a \\u000a \\u000a \\u000a \\u000a Objective The goal of the current study was to map the existing palliative care structures for geriatric patients, the
R. Piers; S. Pautex; V. Curale; M. Pfisterer; M.-C. Van Nes; L. Rexach; M. Ribbe; N. Van Den Noortgate
Geriatrics is in comparison to the other medical professions a relatively new discipline. The calendarical age is not suitable for the characterization of its patient population, the multimorbid old patients. The biofunctional age in terms of the ICF is a better choice. It is characterized in part by physical, psychical, and social context-factors, which can be analysed by geriatric assessments. A better cooperation between basic science orientated gerontological disciplines with the geriatrics will be, beside the implementation into the university medicine and the standardized uniform professional training, of essential importance for the further development of geriatricmedicine. PMID:22131076
Evaluation of pediatric clerkship ratings using generalizability theory is demonstrated. Ratings collected during an academic year are analyzed in a generalizability study, with emphasis placed upon the nature of the designs used to collect ratings. Since decisions regarding students' performances are made with these data, decision-study type analyses were carried out using the generalizability study results. Recommendations are made as
Background At the 2011 Annual Business Meeting of the Canadian Geriatrics Society (CGS), an ad hoc Work Group was struck to submit a report providing an estimate of the number of physicians and full-time equivalents (FTEs) currently working in the field of geriatrics, an estimate of the number required (if possible), and a clearer understanding of what has to be done to move physician resource planning in geriatrics forward in Canada. Methods It was decided to focus on specialist physicians in geriatrics (defined as those who have completed advanced clinical training or have equivalent work experience in geriatrics and who limit a significant portion of their work-related activities to the duties of a consultant). Results In 2012, there are 230–242 certified specialists in geriatricmedicine and approximately 326.15 FTE functional specialists in geriatrics. While this is less than the number required, no precise estimate of present and future need could be provided, as no attempts at a national physician resource plan in geriatrics based on utilization and demand forecasting, needs-based planning, and/or benchmarking have taken place. Conclusions This would be an opportune time for the CGS to become more involved in physician resource planning. In addition to this being critical for the future health of our field of practice, there is increasing interest in aligning specialty training with societal needs (n = 216).
Hogan, David B.; Borrie, Michael; Basran, Jenny F.S.; Chung, A. Maria; Jarrett, Pamela G.; Morais, Jose A.; Peters, Eileen; Rockwood, Kenneth J.; St. John, Philip D.; Sclater, Anne L.; Stultz, Timothy; Woolmore-Goodwin, Sarah
|A description is provided of the miniresidency program in geriatrics at the University of California, San Diego, School of Medicine which focuses on the multidisciplinary approach to the care of geriatric patients. Observations are given as to the program's effectiveness. (GLR)|
This self-directed learning module highlights advances in the evaluation and management of the geriatric amputee. It is part of the chapter on rehabilitation in limb deficiency in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the impact of aging and of comorbid factors on the function of the geriatric amputee. Specific
|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…
McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.
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
Background In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a 'community of practice' with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages. Methods Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis. Results The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors' commitment to their profession, 'handing on' to the next generation and helping their community to attract doctors in the future. Conclusions Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution.
In July 1995, MCP-Hahnemann School of Medicine of the Allegheny University of the Health Sciences introduced its first-ever required clerkship in family medicine. It was decided that computer skills and applications would be an integral part of this rotation, and a special program, CyberDoc, was developed for the clerkship by some of the university's informatics professionals and family medicine faculty. CyberDoc is a suite of laptop-computer applications, based almost exclusively on "off-the-shelf" database and connectivity programs and designed expressly for students at community-based training sites. CyberDoc allows faculty members to track students' progress at off-site clerkships, and allows the students to access pharmaceutical and drug-interaction databases, the university's online academic information system (including MEDLINE), all basic Internet functions, e-mail, and an array of other applications. The authors briefly describe the background, goals, and structure of the CyberDoc project, as well as the preliminary outcomes of CyberDoc's pilot year. PMID:9114890
Maulitz, R C; Ohles, J A; Schnuth, R L; Lipsky, M S; Grealish, R J
... Geriatric Psychiatry to raise awareness of psychiatric and mental health disorders affecting the elderly, eliminate the stigma of mental illness and treatment, promote healthy aging strategies, and ...
Geriatrics and law may not be natural bedfellows. Moreover, law and lawyers were not part of the professions that were the 'founding fathers' of the field of geriatrics. In this short viewpoint we invite the readers to consider a new inter-disciplinary research approach that attempts to combine jurisprudence with geriatrics. Geriatric jurisprudence is a special and timely opportunity for doctors and lawyers to come together in a new, different and more united way to jointly conceptualize a medico-legal theory of aging to better serve our shared community: older and aging persons. PMID:22538767
Background: With the reformed curriculum “4C”, the Medical Faculty of the University of Cologne has started to systematically plan practical skills training, for which Clerkship Maturity is the first step. The key guidelines along which the curriculum was development were developed by experts. This approach has now been validated. Materials and methods: Both students and teachers were asked to fill in a questionnaire regarding preclinical practical skills training to confirm the concept of Clerkship Maturity. Results and discussion: The Cologne training program Clerkship Maturity can be validated empirically overall through the activities of the students awaiting the clerkship framework and through the evaluation by the medical staff providing the training. The subjective ratings of the advantages of the training by the students leave room for improvement. Apart from minor improvements to the program, the most likely solution providing sustainable results will involve an over-regional strategy for establishing skills training planned as part of the curriculum.
Stosch, Christoph; Joachim, Alexander; Ascher, Johannes
This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively
Barbara Carrick Andrews; Judy Kaye; Marilyn Bowcutt; Joseph Campbell
Elderly persons, a rapidly growing population segment, have an increased incidence of cancer. The older cancer patient’s clinical evaluation and treatment is influenced by conditions such as disabilities, comorbidity, and functional status, along with tumor type and stage. These conditions and other geriatric syndromes can be identified by comprehensive geriatric assessment to guide therapy and affect prognosis and quality of
|The director of the Geriatric Authority of Holyoke, Massachusetts, describes the planning, financing, and components of the municipal facility or "geriatric village" for the elderly, which includes skilled nursing and intermediate care, out-patient services, and housing for semi-independent living. (MF)|
Background Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students’ expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships. Aims To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships. Methods Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships. Results Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation. Conclusions Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.
Wenrich, Marjorie; Jackson, Molly B.; Scherpbier, Albert J.; Wolfhagen, Ineke H.; Ramsey, Paul G.; Goldstein, Erika A.
Background: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question.Methods: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were
The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatricmedicine, geriatric dentistry, and geriatric dental public health. PMID:10768266
... Geriatric use” subsection shall contain the following statement(s) or reasonable alternative, as applicable, taking into account available information ... More results from www.fda.gov/drugs/developmentapprovalprocess/formssubmissionrequirements
ILast fall, the critical, educational, and literary movement known as narrative medicine received the definitive stamp of public recognition when it was the subject of feature coverage both in the New York Times and on National Public Radio. Both pieces concentrated on the introduction of narrative writing and discussion groups into the third-year clerkships at the College of Physicians and
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 geriatricmedicine ( n =10) and those who indicated that they were moderately to very interested in…
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 geriatricmedicine and those who indicated that they were moderately to very interested in…
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 geriatricmedicine using a cross-sectional study design. The 233 participants each completed a questionnaire…
The purpose of this study was to assess the impact of an elective geriatric palliative care course on medical students' attitudes, knowledge, and behaviors regarding communication with terminally ill patients. Surveys were administered at the beginning and end of the elective. Despite a significant increase in knowledge about geriatric and palliative medicine (F = 24.80; P < .001), there were
Sandra E. Sanchez-Reilly; Elaine M. Wittenberg-Lyles; Melinda M. Villagran
Extending retirement ages and anti-age discrimination policies will increase the numbers of older workers in the future. Occupational health physicians may have to draw upon the principles and experience of geriatricmedicine to manage these older workers. Examples of common geriatric syndromes that will have an impact on occupational health are mild cognitive impairment and falls at the workplace. Shifts
|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…
|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…
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…
Martin, Vicki L.; Bennett, David S.; Pitale, Maria
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…
|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…
The monograph contains seven separate units of instruction on geriatricmedicine for physician assistants: (1) health promotion in the elderly; (2) biological aspects of aging; (3) psychological aspects of aging; (4) sociological aspects of aging; (5) dis...
|Written by experts in the field of geriatrics, this book is composed of a group of papers. Among the subjects covered in the papers are the news media, the values of the later years, the sciences and aging, and a history of the Home. Several of the articles are written by ministers connected with the religiously oriented facility. Additional…
|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…
The rapid growth in the elderly population in a developing country such as India poses social and financial challenges by causing a shift towards non-communicable diseases and increases in chronic diseases. The economic impact of the burden of chronic diseases such as cardiovascular disease, hypertension, diabetes and cancer are high. The link between oral health and general health are particularly pronounced in older populations and impairs their quality of life. This paper reveals that in order to address the increasing health challenges and demands of a growing geriatric population, undergraduates and graduate students in dental schools should be given comprehensive or holistic health assessment training. Cost-effective modern educational strategies and educational tools such as problem-based learning will help to overcome the dearth of trained faculty in geriatric dentistry. Multidisciplinary health-care approaches and extended health-care team work are of vital importance to older patients who could benefit physically and psychologically from more efficient dental treatment. With often more than one chronic disease affecting individuals and use of polypharmacy, there is a need to increase overall knowledge of geriatric pharmacy and geriatricmedicine. Measures to help older people remain healthy and active are a necessity in developing countries such as India for effective social and economic development. PMID:23691957
The growth of the elderly population presents numerous challenges to the practicing otolaryngologist. This commentary reviews some of the issues that come up in dealing with geriatric patients, reiterates some classic ethical principles, and looks to some philosophers who have addressed relevant issues over the past centuries. It is based on a presentation "Ethical Challenges in Geriatric Otolaryngology," delivered at the annual meeting of the American Society of Geriatric Otolaryngology on April 30, 2008. PMID:19467394
\\u000a Although patients aged 65 and over represent about 13% of the US population, they account for 40% of those undergoing surgical\\u000a procedures in American hospitals. Due to the increased likelihood of comorbidities, older patients also represent a higher\\u000a rate of postoperative complications that influence morbidity and mortality following major surgery. These problems have led\\u000a to the development of several geriatric
Elizabeth A. Capezuti; Patricia Ursomanno; Marie Boltz; Hongsoo Kim
... Geriatric Use Supplement Clinical Efficacy Trials Category. FDA Data Element Number. ... Geriatric Use Supplement Clinical Efficacy Trials Category. ... More results from www.fda.gov/drugs/developmentapprovalprocess/formssubmissionrequirements
|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…
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.
Background. Student perceptions of surgeons and surgical careers may influence their decision to pursue a surgical career. We evaluated the impact of a general surgery clerkship on medical student perceptions of surgeons and surgical careers and of the clerkship on student interest in surgical careers. Methods. We conducted voluntary pre- and postclerkship surveys of third-year medical students who were enrolled
Amalia Cochran; Judy L. Paukert; Leigh A. Neumayer
The emphasis on a generalist professional education has led to shortening and restructuring of the surgery clerkship in the curricula of many medical schools. Little data exist regarding the effect of these changes on student performance. Therefore, we examined the effect of the length, timing, and content of the third year surgery rotation on several clerkship and postclerkship performance measures
D. Scott Lind; Tiffany Marum; Daniel Ledbetter; Timothy C. Flynn; Lynn J. Romrell; Edward M. Copeland
Over 18 months, Medical College of Wisconsin students identified what they had learned during their clerkships in each of seven learning settings; the 3,030 outcomes were divided into 48 categories, and the ten most-frequent learning outcomes are reported. No significant differences by time of year or rural vs. urban clerkships were found.…
Lawrence, Stephen L.; Lindemann, Janet C.; Gottlieb, Mark
Objectives: To investigate how the pediatric clerkship affected student attitudes toward pediatrics, and to de- termine if correlations existed between changes in atti- tudes toward pediatrics and in ratings of certain aspects of the clerkship with an increased interest in a pediatric career. Methods: A one-page survey measuring interest in a career in pediatrics and agreement or disagreement with seven
|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…
Goisman, Robert M.; Levin, Robert M.; Krupat, Edward; Pelletier, Stephen R.; Alpert, Jonathan E.
Objective: The purpose of this study was to evaluate the accuracy of medical student self-assessment of performance on an obstetrics and gynecology clerkship and to assess the influence that demographic and temporal factors had on the accuracy of that assessment. Study Design: From June 1990 to July 2000, 1152 students predicted examination and clerkship grades at the beginning and end
Rodney K. Edwards; Kenneth R. Kellner; Christopher L. Sistrom; Elizabeth J. Magyari
|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…
Niedermier, Julie; Way, David; Kasick, David; Kuperschmidt, Rada
|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…
The growth of the elderly population presents numerous challenges to the practicing otolaryngologist. This commentary reviews some of the issues that come up in dealing with geriatric patients, reiterates some classic ethical principles, and looks to some philosophers who have addressed relevant issues over the past centuries. It is based on a presentation “Ethical Challenges in Geriatric Otolaryngology,” delivered at
|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…
Within the next 15 years, the population of adults 65 years and older in the United States will double to approximately 70 million. Physicians must be well prepared to care for this rapidly growing population. Senior adults comprise a large proportion of most primary care practices in the United States, and the unique needs of this population cannot be overstated. Although traditional preventive screening modalities and disease-specific care models are of great utility, these processes may not be appropriate or consistent with the health goals of many older patients with multiple chronic conditions and reduced functional capacity. This Concise Review highlights commonly encountered clinical scenarios important to the care of these older patients. The topics include diagnosis and management of mild cognitive impairment, assessment of the cognitively impaired driver, cancer screening in the older patient, and sarcopenia. PMID:23726402
Tung, Ericka E; Chen, Christina Y Y; Takahashi, Paul Y
Most veterinarians hold a 'pediatric' rather than 'garage mechanic' view of their function. In recent years, sophisticated medical modalities have allowed veterinarians to keep animals alive, and increased value of companion animals in society has increased demand for such treatment. But whereas humans can choose to trade current suffering for extended life, animals seem to lack the cognitive apparatus required
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
The emergency surgical work load created by patients aged 80 and over in a district hospital was assessed and the results of treatment examined. Over one year 248 patients aged 80 or over were admitted as emergencies, and the overall mortality rate was 21·8%. When terminal disease was excluded mortality rate was 12·5%. These elderly patients had an average length of stay in the acute surgical ward of 14·7 days compared with a mean of 8·4 days for all patients, and all but seven patients were discharged to their original place of referral. Elderly patients do exacerbate the bed shortage in acute surgical wards because they tend to stay longer than younger patients, but these elderly surgical patients imposed only a small load on the inpatient geriatric services, as 78% were discharged straight to their own homes and a further 17% went home after a period on the surgical convalescent wards.
As the U.S. population ages, the prevalence of geriatric conditions in patients with heart failure is increasing, although they currently fall outside the traditional heart failure disease model. In this review, we describe the co-occurrence of four common geriatric conditions (cognitive impairment, frailty, falls, and incontinence) in older adults with heart failure, their mechanisms of interaction, and their association with outcomes. We propose a new paradigm to meet the needs of the aging heart failure population that includes comprehensive assessment of geriatric conditions and tailoring of therapy and surveillance accordingly. Coordination among relevant disciplines such as cardiology and geriatrics may facilitate this transition. Further research is needed in order to understand how to optimize care for patients with specific impairments in order to improve outcomes.
... Understanding this, the geriatric psychiatrist takes a comprehensive approach to diagnosis and treatment, including listening and responding to the concerns of the older adult, helping families, and when necessary, working with ... to treatment. Co-existing medical illnesses, medications, family ...
Geriatric Anesthesia Q & A Share PRINT Print Home > Anesthesia Topics > Detail Page Q: As an older patient, are there any specific ... when driving a car or crossing the street. Q: Who will be my anesthesia provider? A: The ...
The preparation of medical students for clerkship has been criticized, in terms of both students understanding of their new role as clinical trainees and their ability to carry out that role. To begin to address this gap, the authors report the development, implementation, and assessment of a novel program in which first-year medical students shadow first-year residents during their clinical duties. The program matches each student to a single resident, whom they shadow for several hours, once per month, for eight months. In the programs inaugural year (2009-10), 83 student-resident pairs participated; over 70% responded to pre- and post-intervention questionnaires, which included an 18-item preparedness scale. The authors used those responses to evaluate the program. Compared to students in a control group, the students in the program assessed themselves as better prepared to learn in a clinical setting. The low-cost student-resident shadowing program described in this article provided an early and structured introduction to the clinical environment, which may help prepare students for the transition into clerkship. PMID:22836844
Turner, Simon R; White, Jonathan; Poth, Cheryl; Rogers, W Todd
... 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 ...
This article attempts to provide a framework for reflection on the relationships between 2 close specialties, such as geriatrics and palliative care. In medicine today, with the progressive ageing of the population, 80% of deaths occur at a very advanced age, and a high percentage of these are potentially likely to receive palliative care in their final stages. The reflections offered in this presentation are made from a perspective of someone who has always worked in the geriatrics field. Throughout this article, some the common points in the historic evolution of both specialities are made and discussed. The inter-relationships and common ground in other fields may be, their form of understanding medical care, clinical objectives, doctrinal bases, the work methodology, or the overlapping of some elements of training. Several aspects of where they differ on these same points are also discussed. It is concluded with a call for collaboration between the specialists of both fields, as well as in the need to demand that the health administrations introduce larger palliative teams in all hospitals in the country. PMID:23159775
Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population. PMID:20061525
Background: This study was developed to assess study habits of medical students in a third-year surgical clerkship and to determine the relationship of these study habits to performance outcomes.Methods: A questionnaire designed to assess medical student study habits was administered at the end of five consecutive 10-week multidisciplinary surgical clerkships. The results of questionnaires from 81 students were analyzed in
Margaret L Boehler; Cathy J Schwind; Roland Folse; Gary Dunnington; Stephen Markwell; S Dutta
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.…
|Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicineclerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…
There is evidence that geriatric services may be more effective in handling problems of the elderly in acute care. We therefore studied a cohort of matched triplets (age, gender and admission diagnosis), to assess the effect of a geriatric service on elderly problems (falls, pressure ulcers, delirium and functional decline). This is a follow up study; comparing a geriatric unit with an internal medicine unit at two hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City. Socio-demographic characteristics, functionality, emotional state, cognitive status, delirium, co-morbidities, diagnosis, number of medications, presence of pressure ulcers and falls, were assessed. We developed a composite variable as a global end-point, including: delirium, falls, mortality, pressure sores and functional decline. 70 patients were included in the geriatric services and 140 in the internal medicine unit. Mean age =72.5±7 years (±S.D.), and 52.9% were women. At baseline, only illiteracy, quality of life and the number of medications were statistically different between each group. Fully adjusted multiple logistic conditional regression model found an odds ratio of 0.27 (95% CI 0.1-0.7) for the presence of the composite variable, favoring the geriatric unit. Geriatric units in acute care may be beneficial in different frequent end points in elderly. PMID:21782258
Pérez-Zepeda, Mario Ulises; Gutiérez-Robledo, Luis Miguel; Sánchez-Garcia, Sergio; Juárez-Cedillo, Teresa; Gonzalez, Jose Juan García; Franco-Marina, Francisco; García-Peña, Carmen
|Suggests alternatives to the medical education model for teaching geriatrics. Proposes geriatric learning that shows interdisciplinary care, stresses wellness over illness, and demonstrates examples of care, support, independence, and limited maintenance away from nursing homes and hospitals. (Author/ABB)|
The multidimensional geriatric assessment is an interdisciplinary diagnostic process, taking into account several health dimensions. The resulting know-ledge is used to establish a treatment plan. The multidimensional geriatric assessment has shown its efficacy in the acute care treatment of multidimensionally ill and polymorbid patients in acute geriatric structures. The multidimensional geriatric assessment plays a central role in questions regarding the allocation of resources and is becoming more important because of the demographic development and the rapidly changing framework in our health system. It ensures that older patients don't slip through the net in a more fragmented clinical medicine. Growing evidence allows using this assessment approach in polymorbid patients being treated in specialised fields as traumatology, cardiology, oncology and nephrology. PMID:23233101
Despite a rapidly aging population, geriatrics - the branch of medicine that focuses on healthcare of the elderly - is relatively new in India, with many practicing physicians having little knowledge of the clinical and functional implications of aging. Negative attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline contribute to inaccessible and poor quality care for India's old. The aim of this paper is to argue that knowledge translation is a potentially effective tool for engaging Indian healthcare providers in the delivery of high quality geriatric care. The paper describes India's context, including demographics, challenges and current policies, summarizes evidence on provider behaviour change, and integrates the two in order to propose an action plan for promoting improvements in geriatric care.
|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.…
To evaluate the utility of the oral examination in a surgical clerkship, we designed a prospective and randomized study to relate the subjective impressions of experienced examiners with an objective measure of cognitive knowledge. The examiners were asked to score the student's performance as honors, high satisfactory, satisfactory, or unsatisfactory, according to their subjective impression of the student's ability. Student performance was grouped according to oral examination performance. The cognitive performance in the honors group was significantly better than that of the other groups (Student's t-test, p = 0.05). There was a significant difference in cognitive performance for oral examination groups throughout the rotations (analysis of variance, p = 0.000; Kruskal Wallis, p = 0.05). The oral examination is useful to identify a high level of cognitive achievement but cannot discriminate between groups of median to low competence. It should be used for educational feedback, career counseling, residency recommendations, and professional development. PMID:1415946
Hassett, J; Luchette, F; Doerr, R; Bernstein, G; Ricotta, J; Petrelli, N; Stulc, J; Curl, G R; Booth, F M; Hoover, E
Background\\/Objectives: Cognitive dysfunction is a common aspect of the spectrum of symptoms of geriatric depression. High homocysteine levels have been linked to cognitive decline in neuropsychiatric disorders. The present study investigated possible associations between cognitive impairment observed in geriatric depression and homocysteine levels. Methods: The performance of 25 mentally healthy individuals and 40 patients with geriatric depression in terms of
P. Alexopoulos; S. Topalidis; G. Irmisch; K. Prehn; S. U. Jung; K. Poppe; H. Sebb; R. Perneczky; A. Kurz; S. Bleich; S. C. Herpertz
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…
Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.
With this issue, The Consultant Pharmacist begins a new series, Case Studies in Geriatric Pharmacotherapy. This column will present case studies in which the pharmacist identifies actual or potential patient medication-related problems, presents an evidence-based discussion of options, and develops a patient management plan. As part of this evaluation, the pharmacist consults with both the patient's physicians and family members.
The proportion of the population aged 80 to 100years and beyond looks set to increase considerably over the coming decades, which will pose a major public health problem. The specificity of geriatric cardiology as compared to general adult cardiology resides in the fact that every medical intervention requires ethical reflection: to do or not to do? How should we do
This paper calls for a shift away from autonomy as the central value in geriatric ethics. In treatment and experimental settings, differences between older and younger adults are easily attributed to deficiencies on the part of the elderly when autonomy is the central value. Overemphasis on the concept of autonomy skews our understanding of human relationships toward excessively rational models,
Those who provide health care for the elderly are being confronted by a variety of ethical problems, including paternalism, withdrawal of life-support systems, and allocation of scarce resources. Discussion surrounding these issues lacks persuasive power because it lacks an appropriate theoretical grounding. This g aper grounds geriatric ethics in the theory of the person described Stanley Hauenvas. It shows that
|This document is a curriculum guide for a one semester course in geriatrics designed to be taught in high schools in Connecticut. Following introductory material about course philosophy and objectives, and a course outline, the guide contains nine units. Each unit consists of some or all of the following items: time allotment, overview, outline…
Contends that the diagnosis of depression in aged patients is the responsibility of both psychologists, and non-psychologists, for it is the latter that is most likely to make initial contact with an elder in need of help. Describes problems in the use of psychometric tests to identify geriatric depression. Reviews the advantages and disadvantages and limitations of scales currently employed.
T. L. Brink; Jerome A. Yesavage; Owen Lum; Philip H. Heersema; Michael Adey; Terrence L. Rose
In 1965, the federal government passed the Older Americans Act (OAA) and the Administration on Aging (AoA) was created. By that act, older Americans were considered to be persons 60 years of age or older. There are many terms used to define this population of individuals, including geriatric, senior, seasoned, and aged. This chapter uses these terms interchangeably. From a
A vertical curriculum format is one in which material from a given subject is incorporated into multiple courses throughout different years. Such a format for training in geriatrics has been adopted at the University of South Carolina School of Medicine. Earlier, this curriculum was assessed by analysis of self-report from course directors and analysis of class handouts. However, test question
G. Paul Eleazer; Victoria Giles; G. Darryl Wieland
Obesity is a rapidly growing epidemic that now affects approximately 30% of the adult population in the United States. The prevalence of obesity in the geriatric population makes it one of the fastest growing groups due to aging baby boomers. Because of the limited number of available treatments for obese adults, they often turn to supplements and alternative medicine sources
Geriatricians have embraced the term ''geriatric syndrome,'' using it extensively to highlight the unique features of com- mon health conditions in older people. Geriatric syn- dromes, 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
Sharon K. Inouye; Stephanie Studenski; Mary E. Tinetti; George A. Kuchel
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.
The number of geriatric citizens is increasing. Those who are edentulous and have been wearing complete dentures face increasing difficulty coping with these prostheses. Those who have natural teeth as they enter old age should be encouraged and assisted in every possible way to keep these teeth, since the likelihood of adjusting to dentures at this age is slim. ImagesFigure 4Figure 5Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13
Personalizing a patient’s course of cancer therapy is of utmost relevance to the geriatric population. Advances in diagnostic\\u000a radiology and radiation technology have improved tolerability for this group and expanded treatment options. Better images\\u000a to visualize the tumor with PET\\/CT or MRI can be registered to the CT data acquired with the patient in the treatment position\\u000a so that a
Objective: The NBME Psychiatry Subject Examination (PSE) is used throughout North America to test MS-III end-of-clerkship knowledge; yet, literature on PSE preparatory methods remains sparse. This study assesses the effect of a curriculum intervention on NBME PSE scores. Method: An optional 1.5-hour review session and accompanying…
Sidhu, Shawn S.; Chandra, Rohit M.; Wang, Lei; Gollan, Jacqueline K.; Rasminsky, Sonya; Brar, Simerjeet K.; Anzia, Joan M.
|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'…
|Objective: The NBME Psychiatry Subject Examination (PSE) is used throughout North America to test MS-III end-of-clerkship knowledge; yet, literature on PSE preparatory methods remains sparse. This study assesses the effect of a curriculum intervention on NBME PSE scores. Method: An optional 1.5-hour review session and accompanying…
Sidhu, Shawn S.; Chandra, Rohit M.; Wang, Lei; Gollan, Jacqueline K.; Rasminsky, Sonya; Brar, Simerjeet K.; Anzia, Joan M.
Evaluation of changes in a human genetics course for medical students at the University of Illinois, which incorporated clerkship features including case studies, small group work, and library research, found significant gains in student achievement and favorable assessments by students and faculty. (Author/DB)
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.…
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…
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…
Levine, Ruth E.; Kelly, P. Adam; Karakoc, Tayfun; Haidet, Paul
Drug information is a well-known career path for many pharmacists. To expand the educational opportunities available for pharmacy students, a drug information clerkship program in an industry setting was initiated at Searle. The goals and objectives for the pharmacy student during this rotation are clearly defined, focused on understanding the role of a pharmacist in a medical information services department
|Objective: The authors investigated the association between psychiatry clerkship timing and pattern of student performance. Student rotation timing preference and specialty choice were explored as potential moderators. Methods: Archival data from six classes of third-year medical students were analyzed. Performance indicators included the…
|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…
|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…
Morreale, Mary; Arfken, Cynthia; Bridge, Patrick; Balon, Richard
|Four years of experience with an objective structured clinical examination (OSCE) following an eight-week surgical clerkship (n=356 students) are reported, including data on mean student performance across years, reliability coefficients, and generalizability. Implications for improvement and development of OSCE are discussed. (Author/MSE)|
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)
|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…
|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…
|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…
Despite the development of new information tools, thc interdisciplinary nature of aging research still hampers those in gerontology and geriatrics from accessing its information base. The growth of special resource centers, such as the Gerontological Information Program (GRIP) and the New York Statewide Resource Center for Geriatric Education, shows the need for intermediary information services to bridge the gap between
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
One of the impacts of population ageing will be an increasing need for a suitably trained medical workforce. This review of literature published in English and Spanish between January 2004 and September 2009 explores different approaches to geriatric training around the world. Eight options are considered: core competencies, establishing a geriatrics department, incentives through grants, curricular approaches, traditional and innovative
This study addresses the effectiveness and tolerability of venlafaxine in geriatric psychiatry outpatients with treatment refractory major depression. All patients from a geriatric psychiatry outpatient clinic with major depression who had received at least one prescription for venlafaxine during a 12 month period were examined for treatment refractory criteria. Ten patients receiving venlafaxine met strictly defined criteria for treatment refractory
OBJECTIVE Medical educators have attempted in recent years to provide quality clinical experiences for medical students early in their medical training. We questioned whether participating in a preceptorship in internal medicine (PIM) resulted in better performances on subsequent clinical rotations and increased interest in internal medicine. PARTICIPANTS Fifty-four students have participated in the PIM to date, with control groups consisting of students who applied for it but were not selected (n = 36), students participating in a preceptorship in family medicine (n = 168), and the remaining students (n = 330). DESIGN Prospective cohort study. SETTING University medical center and community practices. INTERVENTION A 2-month, clinical preceptorship following the first year of medical school. MEASUREMENTS AND MAIN RESULTS The following outcomes were assessed: scores in the introduction to clinical medicine course; grades in the medical ethics course; scores from the internal medicineclerkship; and choosing a career in internal medicine. In their second year, PIM students scored higher in both semesters of the introduction to clinical medicine course (87% and 86% vs 84% and 84%, p’s < .01) and were more likely to receive honors in ethics (50% vs 29%, p < .01) than non-PIM students. During the internal medicineclerkship, PIM students’ scores were significantly higher on an objective structured clinical examination (79% vs 76%, p = .05), ambulatory clinical evaluations (80% vs 76%, p < .01), and overall clerkship scores (78% vs 75%, p = .03) but not on inpatient clinical evaluations or on the National Board of Medical Examiners Subject Examination. Preceptorship students were more likely to receive honors grades in the medicineclerkship (33% vs 10%, p < .01), and they were more likely to match into internal medicine residencies than control students (54% vs 27%, p < .01). CONCLUSIONS The PIM course is an intervention, early in students’ careers, which appears to benefit them academically and increase their interest in internal medicine as a career.
Elnicki, Michael D; Halbritter, Kevin A; Antonelli, Mary Ann; Linger, Barry
The purpose of this study was to determine how a medical student's self-assessment at the completion of the third-year Ob/gyn clerkship compares with the institution's final grades at Lehigh Valley Hospital. From November 2002 to November 2003 at completion of each six-week Ob/gyn clerkship rotation, 47 medical students assessed themselves on the following parameters: fund of knowledge, personal attitude, clinical problem-solving skills, written/verbal skills, and technical skills. Additionally, they were asked to predict their performance on the NBME Shelf Exam. Their assessments were then compared with their final clerkship grades in each of the above parameters. Chi-squared and Kendall-tau tests were used to analyse the data for degree of agreement and association, respectively. There was a statistically significant weak to moderate, positive correlation between students' self-assessment and final clerkship grade for written/verbal skills (p = 0.002, r = 0.390). A statistically significant agreement between raters was also revealed for written/verbal skills (p = 0.003). Weak, non-statistically significant, positive relationships were revealed for fund of knowledge, clinical problem-solving and technical skills. A weak, negative, non-significant relationship was revealed for personal attitudes, and there was no statistically significant relationship between students' prediction of NBME score and categorized true score (p = 0.717, r = 0.49). At the end of their Ob/gyn clerkship, third-year medical students are better at assessing their technical and written/verbal skills than their global fund of knowledge and personal attitudes. These results may suggest that students are not aware of their own personal attitudes and communication skills and how they can affect their effectiveness as a physician. PMID:16147799
Weiss, Patrice M; Koller, Craig A; Hess, L Wayne; Wasser, Thomas
The authors reviewed the literature on the pharmacotherapy of geriatric mood disorders. Based on the evidence available, we have proposed: (i) that although any antidepressant is assumedly equal in antidepressive efficacy, ones with weak anticholinergic and antialpha1 effects are preferable in geriatric patients; (ii) that augmentation therapy with lithium and methylphenidate has modest evidence of efficacy in this population; (iii) that modified electroconvulsive therapy is safe and effective for severe and psychotic depression in the elderly; and (iv) that lithium remains the first choice for geriatric bipolar disorder, although its optimal serum level may be lower than in younger adults. PMID:10560900
Issues related to prescribing dermatologic drugs in the elderly are less recognized than age-related skin findings. This is related in part to the lack of a standardized residency training curriculum in geriatric dermatology. As the number of elderly patients rises in the United States, drug-related iatrogenic complications will become increasingly important. This review discusses age-related changes in pharmacokinetics and pharmacodynamics of common dermatologic drugs. These changes include volume of distribution, renal function, liver toxicity from interactions of commonly prescribed drugs, and medications that can decompensate cognition in the older patient population. We outline seven prescribing principles related to older dermatology patients, including useful strategies to reduce polypharmacy and improve drug adherence, using an evidence-based approach whenever possible. PMID:23522421
Endo, Justin O; Wong, Jillian W; Norman, Robert A; Chang, Anne Lynn S
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
The authors describe the design and implementation of a new Web-based system that allows students to record important features of their clinical encounters during all 10 required clinical clerkships, document their learning experiences in six major competency domains, and generate detailed real-time reports for themselves and their clerkship directors. A new Web-based system, DMEDS (Dartmouth Medical Encounter Documentation System), accepts input from computers and PDAs. Its design permits students to describe their patients, learning sites, interactions with preceptors, and important aspects of their clinical encounters in all of our medical school's competency domains. Using a common format for all required clerkships, clerkship directors select specific items most relevant to their clerkships from a common menu and set learning targets for specific diagnoses and clinical skills. This new system was designed in the fall of 2003, tested in the spring of 2004, and implemented in all clerkships for the 2004 to 2005 academic year. During the first full academic year that DMEDS was used, students documented nearly 32,000 discrete student-patient-preceptor encounters, an average of between 21 and 120 clinical encounters per Year 3 clerkship. Highlights of the analysis of these initial data include the following: (1) insights into how educational targets are set, (2) the extent of site-to-site variation in clerkship experiences, (3) the epidemiology of patients' declining student involvement, and (4) student experiences in and understanding of the newer competency domains.DMEDS can be used in all clinical clerkships and can address student experiences in all competency domains. It provides substantial value to students, clerkship directors, preceptors, and medical school administrators. As secondary benefits, the authors found that DMEDS facilitates educational research and is readily adapted for use in residency and fellowship programs as well. Student feedback highlights the need to pay close attention to the time invested by students documenting their clinical encounters. Course directors must ensure that the benefits to students (such as knowledge of meeting learning targets and preceptors providing direct feedback to students) are transparent. Finally, for other schools contemplating the change to a competency-based curriculum with the use of a clinical encounter documentation system, the time required for both students and faculty to adopt and fully engage these major educational culture shifts seems to be at least several years. PMID:17198293
Nierenberg, David W; Eliassen, M Scottie; McAllister, Stephen B; Reid, Brian P; Pipas, Catherine Florio; Young, William W; Ogrinc, Greg S
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 GeriatricMedicine 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
Leng, Sean X; Tian, Xinping; Liu, Xiaohong; Lazarus, Gerald; Bellantoni, Michele; Greenough, William; Fried, Linda P; Shen, Ti; Durso, Samuel C
Physicians should be cognizant of the multitude of unique issues that their geriatric patients present and aware of the overall elder patient's general health status both physically and cognitively, potential drug interactions, and their short-term as well as long-term goals. While respecting patients' autonomy, we must evaluate their ability to make their own decisions regarding their health care. This will require time and patience on our part. We also must overcome our own potential prejudices about what we view as important for the older patient. Finally, we may need to appropriate involve family members or caregivers in the decision-making processes and care of our elderly patients. To properly and ethically care for this distinct and vulnerable population, with their myriad of complex issues, it is important that dermatologists understand their unique issues and challenges. PMID:22902222
Fontanella, Demian; Grant-Kels, Jane M; Patel, Trupal; Norman, Robert
Palliative care and geriatrics share many ideas and concepts: both intend to imporve quality of life, both focus on more than the physical domain, and both work in a multiprofessional team. More and more the elderly person attracts notice by palliative care. In multimorbid geriatric patients intentions to cure and to care go alongside sometimes over years in a fragile equilibrium and with uncertain prognosis. Therefore principals of palliative care and geriatrics meet at its best in these patients: improving function plays a major role in any symptom management; how to deal with cognitively impaired patients can be learned from geriatrics; various approaches from curative, palliative and rehabilitative often go hand in hand; decision making is a permanent and sophisticated task in all patients due to prognosis and multimorbidity. PMID:22334203
The concept of maintenance therapy and its application in the prolonged treatment of geriatric patients are examined. Maintenance therapy encompasses therapeutic measures that retard deterioration in patients who are chronically ill either by slowing the ...
|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…
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 medicineclerkship 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.
The geriatric evaluation unit (GEU), or geriatric assessment unit (GAU), is an increasingly popular component of the health care system. Interdisciplinary assessment and management by GEU teams is an effective way to lower the cost of long-term care for frail elderly hospital patients. Optometry can play a very important role on the GEU team because of the importance of vision assessment and care for the elderly. PMID:3397480
This training model used self-study, home-based therapeutics instruction and a clerkship strategy to train rural community pharmacy preceptors in pharmaceutical care (PC). Specific aims were to: (i) provide intensive instruction in clinical and managerial aspects of setting up a PC model in a rural community phar- macy setting, and (ii) assess effectiveness of the instruction through post-training assessment of PC
David M. Scott; Warren A. Narducci; Paul W. Jungnickel; Lucinda G. Miller; Anthony E. Ranno; Pierre A. Maloley
Prescribing correctly represents one of the most essential skills of a doctor when it comes to patient safety. Unfortunately,\\u000a prescribing errors still account for a large proportion of avoidable drug-related problems (DRP). Despite this shortcoming,\\u000a many medical schools do not provide specific prescribing training and assume that students acquire sufficient prescribing\\u000a skills during regular medical clerkships. We therefore investigated whether
N. Celebi; K. Kirchhoff; M. Lammerding-Köppel; R. Riessen; Peter Weyrich
Patient encounter logs allow faculty to monitor students' clinical experiences, especially in decentralized clerkships. However, there are generally tradeoffs involving the expressiveness of patient encounter forms, the effort required to complete the forms, and the utility of the forms for informing the clerkship director. The family practice clerkship at Washington University changed the school's standard free text, paper log to a controlled vocabulary paper log, borrowing 93 generic ICD-9 codes and the SNOMED concept of 'process at location' phrases for localized problems. Subsequently, this architecture was used in a Palm computer program. Students using the structured paper logs documented slightly more patient encounters than students using free text logs in the previous year, with similar numbers of problems per patient (1.3 to 1.4) and prevalence of common illnesses, but used the phrase structure and code vocabulary inconsistently. Students using computer logs documented many more patient encounters, but only documented 1.09 problems per patient. Students' documentation of psychosocial diagnoses declined significantly with the computer log. Although the computer program was flexible, the effort required to enter multiple problems exceeded the effort of finding similar codes on a short paper form. This problem confounds efforts to monitor exposure to complex patients and hidden medical problems. Another design for the hand-held computer log is being tested.
A nationwide network of Geriatric Education Centers (GECs) was established in 1983 to address the need for substantially more health professions faculty and practitioners with geriatric knowledge and skills. The Public Health Service supported 31 centers during fiscal year 1992. A 1988 article in the Journal provided an initial examination of the purpose, structure, and programs of GECs. This article
Background A large body of research has focused on “mediating mechanisms” and predisposing brain abnormalities to geriatric depression, but little is known about its etiology. This paper examines whether age-related and comorbid disease-related immune deregulation is an etiologic contributor to geriatric depression. Methods This article reviews findings on neuroinflammation during the aging process and depression as well as studies of anti-inflammatory actions of classical antidepressants and antidepressant actions of anti-inflammatory agents. Results Aging results in increased peripheral immune responses, impaired peripheral-CNS immune communication, and a shift of the CNS into a pro-inflammatory state. These exaggerated and prolonged immune responses may lead to changes in the function of emotional and cognitive networks pertinent to geriatric depression and to behavioral changes reminiscent of the depressive and cognitive symptoms of geriatric depression. Some antidepressants may reduce the expression of inflammation markers. Limited data suggest that some anti-inflammatory agents may have antidepressant properties. Conclusions A synthesis of available findings suggests that aging-related and comorbid disease-related inflammatory processes may promote changes in the neural systems predisposing to geriatric depression or facilitating metabolic changes that mediate depressive syndromes. The “inflammation hypothesis” in geriatric depression cannot be tested in its entirety, but it can lead to testable hypotheses and data on mechanisms by which inflammatory processes promote geriatric depression. The significance of such an effort is that it may lead to a novel treatment development model bringing to bear recent advances of anti-inflammatory pharmacology to the treatment of depressed elderly patients.
|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…
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…
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 in the Philippines where there is no stand-alone geriatric
Allan B. de Guzman; Andrei Angelo R. Cruz; Angela Laurice G. Cruz; Robert Edward D. Cruz; Jose Mari Niño L. Cuarto
The need for trained geriatric social workers is extensive and growing. The current supply of trained geriatric social workers is limited. Strategies to reduce the gap between the demand for and the supply must be approached from all levels of formal social work education, including an active program of geriatric social work continuing education.
|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…
Clark, Elizabeth; Fitzgerald, James T.; Griffith, Jennifer; Weir, Charlene
Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.
Chakravarthy, Bharath; ter Haar, Elizabeth; Bhat, Srinidhi Subraya; McCoy, Christopher Eric; Denmark, T. Kent; Lotfipour, Shahram
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.
Carpenter, Christopher R.; Heard, Kennon; Wilber, Scott; Ginde, Adit A.; Stiffler, Kirk; Gerson, Lowell W.; Wenger, Neal S.; Miller, Douglas K.
Abstract Objectives To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology. Methods Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship. Results Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p?=?0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p?0.0001) and physical examination (p?0.0001). Male students were also more likely to report feeling that their gender negatively impacted their clerkship experience (p?0.0001). Although less likely to report preclerkship and postclerkship career interest in obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship. Conclusions Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students.
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.
Geriatricians have embraced the term "geriatric syndrome," using it extensively to highlight the unique features of common health conditions in older people. 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, although 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
Inouye, Sharon K; Studenski, Stephanie; Tinetti, Mary E; Kuchel, George A
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.
Inouye, Sharon K.; Studenski, Stephanie; Tinetti, Mary E.; Kuchel, George A.
|The project investigated the effectiveness of an evironmental therapy training program for geriatric mental health workers when used in two different institutional settings. Site A was a State-operated facility for psychiatric in-patient care, accommodating 2,000 patients, with emphasis on maintenance and general patient welfare. Site B, a former…
|The Trowbridge House Geriatric Aide Program, performed at MDTA centers in Akron and Cleveland, Ohio, was developed to demonstrate whether the active and positive recruiting methods widely used by proprietary schools could be adapted to obtain more and better qualified disadvantaged persons for skills training; whether a high quality,…
Their project tested the hypothesis that drinking beer has a positive effect on the behavior & well being of the severely incapacitated geriatric patient. The hypothesis was found to be true after 2 groups of patients were organized. One group was provide...
Because of their increased incidence of illness and disability, geriatric patients require extra time and diligence to assess and track medical problems. This article describes a comprehensive geriatirc assessment, organized on a one-page, easily updated checklist, that can be used to generate a medical and functional problem list and a risk assessment. Imagesp2190-a
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
|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…
Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Health Professions.
A total of 27 subjects began active treatment in this double-blind study comparing the efficacy and safety of trazodone and fluoxetine in geriatric depressed patients, but only 13 completed 6 weeks on study medication. Both agents were effective according to weekly and endpoint analyses, and there was no evidence of significant effects on blood pressure, pulse, or weight. Separate analysis
William E. Falk; Jerrold F. Rosenbaum; Michael W. Otto; Paul M. Zusky; Jeffrey B. Weilburg; Ralph A. Nixon
Aim: To evaluate the safety of tubeless percutaneous nephrolithotomy (PCNL) in geriatric patients. Materials and Method: This is a retrospective review of 401 patients who received tubeless PCNL in a single institute. Among these, 50 were performed in patients aged older than 70 years (group 1), while 351 were performed in the remaining younger patients (group 2). Results: There was
Cancer incidence increases with advanced age. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and NCI, have summarized the gaps in knowledge in geriatric oncology and made recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. Information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment, and to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study end points that address the needs of the older and/or vulnerable adult with cancer and to build a better infrastructure to accommodate the needs of older adults to improve their representation in trials. We use a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge of best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed. PMID:22825377
The new clinical practice guideline on Comprehensive Geriatric Assessment (CGA) issued by the Dutch Geriatrics Society aims to optimise the diagnostic strategy in secondary care geriatric patients in order to achieve a treatment plan that will retain self-reliance and quality of life of these patients for as long as possible. An extensive listing of all somatic, psychological and social factors that could affect the health and welfare of all frail patients forms the basis of this guideline. This is actually an essential goal for any patient, regardless of age and condition. Knowledge of the optimal diagnostic tests and therapy for elderly patients, and a financial evaluation of such assessments are still lacking. Moreover, it remains to be seen if such a thorough assessment by a medical specialist is feasible and desired. The authors suggest using the proposed CGA as a starting point for a broad discussion between geriatric specialists, other medical specialists and general practitioners before implementing this as a general guideline. PMID:22217309
While this volume was designed mainly as an update and review for practicing, primary care physicians, it will also be valuable for physicians-in-training, some medical specialists and other health care providers. The volume brings together the most curre...
R. D. T. Cape R. M. Coe I. Rossman J. Tobin R. W. Besdine
Background Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice ‘teaching microsystem’ and participate in patient care as part of this community of practice (CoP). This study evaluates patients’ perceptions of the clerkship initiative, and their perspectives on this approach to training ‘much-needed’ doctors in their community. Methods Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes. Results The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as ‘becoming’. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care. Conclusions Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice ‘teaching microsystem’ allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.
Drug causation assessment is a systematic process, designed to estimate the probability of a drug's implication in the onset of an adverse event. Postmarketing surveillance is very useful for geriatricmedicine, because it gives a better idea of a drug's efficiency and safety in special populations, such as older adults. Although the probabilistic reasoning used in drug causation assessment often
D. Samaras; N. Samaras; P. Antonini; C. Ferrier; N. Vogt-Ferrier
Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients. PMID:23728022
Brown, Rebecca T; Kiely, Dan K; Bharel, Monica; Mitchell, Susan L
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…
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…
Gardner, Davis L., Ed.; Hoekelman, Margaret C., Ed.
Thirty geriatric long-stay patients aged 65-94 years (mean 81.8) participated in the trial the aim of which was to examine bulk laxative plus senna (Agiolax®) in the treatment of chronic constipation using lactulose (Levolac®) as a reference medicine. Bulk laxative plus senna (daily dosis 14.8 g) produced more frequent (p < 0.05) bowel habits (4.5 vs. 2.2-1.9\\/week) than lactulose (daily
O. Kinnunen; I. Winblad; P. Koistinen; J. Salokannel
Besides extended life expectancy, the globalization, increased mobility and migration are additionally influencing the structural change of the society. Thereafter, the problem of multiculturalism, as known within the school system, will soon also become relevant in the geriatrics. Thus, being in a foreign country as an elderly person can aggravate the common geriatric problem of isolation. Because of better communication, compliance as well as better quality of life, one should strive for empathy between physician and patient. This requires the physician's sensibility for individual aspects of the patient's history, as well as knowledge, or at least a readiness for learning more about other cultures, religions and traditions. Specifically, fundamental aspects of Islam, Eastern Christianity, Judaism and Far-East religious and cultural understanding are presented. PMID:18807238
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.
This article reports the results from a survey of gerontology and geriatrics education in Schools and Colleges of Pharmacy and from a survey of state-level Associations for Home Health Care on their involvement with aging-related education and training. Results indicate that pharmaceutical education programs, as a whole, do not have adequate coverage of aging-related material and suggest a lack of
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
Souder, Elaine; Beverly, Claudia J; Kitch, Stephanie; Lubin, Sandie A
Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs. PMID:21227518
Karabulut, Hayriye; Baysal, Selcan; Acar, Baran; Babademez, Mehmet Ali; Karasen, Riza Murat
Determination of the impact of programs designed to enhance the functional independence of geriatric residents requires prior specification of goals in terms that clearly indicate the desired outcomes. The Geriatric Resident Goals Scale (GRGS) is a listing of specific goals developed to provide a systematic means of assessing resident status and program effectiveness. For male residents in a VA Nursing Home Care Unit, the obtained internal consistency reliability coefficient was .97 (N = 198), and the reliability coefficient reflecting a combination of test-retest and interrater consistency was .95 (N = 22). For a group of 178 residents, the GRGS was predictive of level of independence ratings (r = .82) and mental status (r = .71). The data showed the GRGS to be a highly reliable and valid means of assessing the functioning of geriatric residents, lending support to an assessment process based on a listing of specific goals. The GRGS can be viewed as a general procedure that is adaptable to a range of geriatic settings and programs. PMID:681655
Cancer has a high prevalence in older age. The management of cancer in the older aged person is an increasingly common problem. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. In the elderly, the comorbidities and physiological changes in the pharmacokinetics reduce the prospective for therapy and suggest the importance of a multidimensional assessment of cancer patients as well as the formulation of predictive models of risk, in order to estimate the life expectancy and tolerance to treatment. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardio toxicity and neurotoxicity. The chemotherapy in patients older than 75 years is very limited. The geriatric assessment is considered a valid tool in geriatric medical. It is important for two main reasons: first of all, for the need to distinguish the features linked to the geriatric syndromes from those ones which are strictly connected to the cancer pathology; secondly, for its potential prognostic value. PMID:24102283
We investigated the values and attitudes of junior medical students in relation to career preference (particularly surgery), ward behavior, and cognitive performance in the surgical clerkship. Students choosing specialty surgery were more cynical and authoritarian than those selecting general surgery. Those choosing general surgery had more self-esteem, and along with those who selected specialty surgery, more intolerance for ambiguity than other students. None of the values or attitudes were associated with grades, but several were related to ward behavior as judged by faculty and house staff. Students who valued academic achievement more and independence and intellectualism less and those with more submissive authoritarian views and more ego strength were considered better ward performers. This raises the question of whether such values and attitudes should be reinforced in ward performance or whether such students are rated higher simply because they are less disruptive to busy ward routines. PMID:7125891
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.
Although a growing body of literature supports the expansion of patient and family involvement in healthcare processes, little attention has thus far been directed at activating geriatric home care patients and\\/or families to be more effective in managing health-related activities. In this manuscript we consider the unique needs, attributes, and circumstances of the geriatric home care population in conjunction with
Jennifer L. Wolff; Debra L. Roter; Barbara Given; Laura N. Gitlin
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 in geriatrics. A mail questionnaire survey
Emily Lubart; Refael Segal; Vera Rosenfeld; Jack Madjar; Michael Kakuriev; Arthur Leibovitz
Pharmacists (N=233) responded to the question "What is the most difficult aspect of geriatric pharmacy practice?" Most commonly cited problems were (1) inadequate professional skills or knowledge in geriatrics; (2) patient compliance; (3) physician functioning (including overprescribing of medications); (4) communication with the elderly; (5) lack…
Pica has rarely been reported in patients with geriatric mental illness. The authors describe 3 male patients with pica in the geriatric unit of a state mental hospital. Two of these patients had a diagnosis of developmental delay with concomitant diagnoses of schizophrenia and schizoaffective disorder, respectively. The third patient was diagnosed with paranoid schizophrenia. In all 3 cases, pica
Noel I. Dumaguing; Indra Singh; Mohammad Sethi; D. P. Devanand
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…
Gazewood, John D.; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles
hat is geriatric psychiatry? Simply put, it is the subspecialty dealing with the assessment and manage- ment of mental disorders occurring in late life—a period occa- sionally and somewhat arbitrarily defined as aged 65 years and over (1). This definition falsely simplifies what we do as geriatric psychiatrists and does not acknowledge the scope of practice and the specific skills
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…
de Guzman, Allan B.; Cruz, Andrei Angelo R.; Cruz, Angela Laurice G.; Cruz, Robert Edward D.; Cuarto, Jose Mari Nino L.
Ethical concerns related to human research, such as informed consent, are areas of continued interest in clinical studies. Consent that is competent, informed, and voluntary is vital to successful studies. Additional concerns of beneficience and justice are also of concern. Research with geriatric patients can bring complications, especially where dementia is present. Sensitivity to these concerns is vital in geriatric
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 of mentoring, (b) reactions of mentors and mentees, and (c) the effect of intervening variables. Trained
J. James Cotter; Constance L. Coogle; Iris A. Parham; Colleen Head; LaQuana Fulton; Kathleen Watson; Angela Curtis
many ways similar to coordinated stroke units, 3 may improve mortality and other clinically relevant outcomes compared with outcomes achieved on a general medical ward. An alternative strategy, reviewed elsewhere in this Report, is the comprehensive geriatric consultation service, analogous to a typical medical consultation team (see Chapter 29). In a GEM unit, a multidisciplinary team provides comprehensive geriatric assessment,
Joseph V. Agostini; Dorothy I. Baker; Sidney T. Bogardus
In France, the incidence and rate of mortality of cancer increase with age. For elderly patients suffering from cancer, the standard geriatric assessment, together with an oncological assessment aims to optimise the treatment. This geriatric oncology assessment enables the priorities to be identified and the cancer treatment to be adapted by anticipating the risks and organising the support care. PMID:23409678
Bandura's social learning theory provides a useful conceptual framework to understand medical students' perceptions of a house calls experience at Virginia Commonwealth University School of Medicine. Social learning and role modeling reflect Liaison Committee on Medical Education guidelines for "Medical schools (to) ensure that the learning environment for medical students promotes the development of explicit and appropriate professional attributes (attitudes, behaviors, and identity) in their medical students." This qualitative study reports findings from open-ended survey questions from 123 medical students who observed a preceptor during house calls to elderly homebound patients. Their comments included reflections on the medical treatment as well as interactions with family and professional care providers. Student insights about the social learning process they experienced during house calls to geriatric patients characterized physician role models as dedicated, compassionate, and communicative. They also described patient care in the home environment as comprehensive, personalized, more relaxed, and comfortable. Student perceptions reflect an appreciation of the richness and complexity of details learned from home visits and social interaction with patients, families, and caregivers. PMID:20509061
Abbey, Linda; Willett, Rita; Selby-Penczak, Rachel; McKnight, Roberta
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
|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…
Hajjar, Ihab M.; Ruiz, Jorge G.; Teasdale, Thomas A.; Mintzer, Michael J.
Lymphomas, carcinomas, leiomyomas, and stromal tumors are the most common tumors found in the canine and feline gastrointestinal tract. Endoscopic and surgical biopsies are often the mainstays of diagnosis, although ultrasound is playing an increasingly greater role. Small cell lymphocytic lymphoma of the feline intestines poses a special diagnostic dilemma and may require immunohistochemistry as well as polymerase chain reaction to distinguish it from lymphocytic-plasmacytic enteritis. This article will focus on the more common neoplastic problems of the esophagus and gastrointestinal tract (GIT) of geriatric dogs and cats. PMID:22720809
95 Recently, many developing countries have had changes in the composition of population and have become aging societies. Therefore, anti-aging medicine which is believed to have beneficial effect on the risk factors of geriatric associated diseases has been paid much attention. Complementary and alternative medicine (CAM) has been widely accepted by the general population, and is consequently known to account
Hyun Jung Kim; Hoon Kim; Jung-Ho Shin; Seung-Yup Ku
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
The authors collected data on all patients admitted to the Sepulveda Veterans Administration Geriatric Evaluation Unit (GEU) during its first 6 years of operation. Analysis of these data indicate several beneficial effects associated with this type of specialized geriatric care: improved diagnostic accuracy, reduced use of drugs, improved functional status, and improved placement location. The authors also analyzed additional data from a previously published, randomized controlled trial to compare better process of care between patients randomized to the GEU and those receiving usual services. During their initial hospitalizations, GEU patients received significantly more specialty evaluations than controls (4.9 versus 1.7, p less than .001), had longer lengths of stay (85.1 days versus 44.3 days, p less than .001), had more new diagnoses discovered (2.9 versus 0.6, p less than .001), and had more drugs discontinued from their regimens (4.6 versus 2.3 p less than .001). These process differences were probably related to the previously reported outcome differences: GEU patients were more likely than controls to show improvements in functional status, affect, placement location, use of institutional services, and survival. PMID:3815239
Rubenstein, L Z; Josephson, K; Wieland, G D; Pietruszka, F; Tretton, C; Strome, S; Cole, K D; Campbell, L J
Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent. PMID:16735082
The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly. PMID:22176832
Medina-Chávez, Juan Humberto; Torres-Arreola, Laura Del Pilar; Cortés-González, Rosa María; Durán-Gómez, Verónica; Martínez-Hernández, Fernando; Esquivel-Romero, Gustavo
Background/Purpose To describe geriatric training initiatives implemented as a result of Reynolds Foundation grants awarded in 2001 (and concluding in 2005) and evaluate the resulting structure, process, and outcome changes Methods Cross-sectional survey of program directors at 10 academic institutions augmented by review of reports and secondary analyses of existing databases to identify structural and process measures of curriculum implementation, participation rates, and students’ responses to Association of American Medical Colleges Medical School Graduation Questionnaires about geriatrics training. Results All 10 institutions reported structural changes including newly developed or revised geriatric rotations or courses for their trainees. Most used online internet educational materials, sent students to new training venues, incorporated geriatric case discussions, implemented standardized patients, and utilized digital media. On average, each institution trained over 1,000 medical students, 500 residents, 100 faculty, and 700 non-faculty community physicians during the award period. Reynolds institutions also provided geriatrics training across 22 non-primary care disciplines. Eight schools implemented formal faculty development programs. By 2005, students at Reynolds-supported schools reported higher levels of geriatrics/gerontology education and more exposure to expert geriatric care by the attending faculty compared to students at non-Reynolds schools. Innovations and products were disseminated via journal publications, conference presentations, and POGOe (Portal of Geriatric Online Education). Conclusions The investment of extramural and institutional funds in geriatrics education has substantially influenced undergraduate, graduate, and practicing physician education at Reynolds-supported schools. The full impact of these programs on care of older persons will not be known until these trainees enter practice and educational careers.
Reuben, David B.; Bachrach, Peter S.; McCreath, Heather; Simpson, Deborah; Bragg, Elizabeth J.; Warshaw, Gregg A.; Snyder, Rani; Frank, Janet C.
Psychologic assessment is an integral aspect of the comprehensive functional assessment of geriatric patients. Medical areas in which psychologic testing and evaluation can be of significant service in the diagnosis and formulation of treatment plans include psychiatric and neurologic disturbances, psychosomatic disorders, circulatory diseases (especially hypertension), diabetes, chronic pain, sexual dysfunctions, and gastrointestinal problems. In the effort to gain an understanding of the total patient, it is important to clarify the effect of physical condition on a person's psychologic reactions as well as the impact of psychologic states on his/her biologic status. This orientation is particularly important in dealing with elderly patients because the interaction between the physical and the psychologic in this age group is exceedingly strong and significant. Despite the fact that research in the psychology of the aged is of long standing, the attention given by clinical psychologists to the provision of services to geriatric patients has been quite limited until recently. Many psychologic tests have been developed during the past 70 years, but relatively few of them have been standardized for use with the aged. Of late, however, this has been changing. Several tests have been adapted, and some new ones have been organized with the needs and characteristics of the aged in mind. Closer attention has been paid to psychometric principles in the development of the tests, leading to the organization of useful norms and the demonstration of proper levels of reliability and validity. Accordingly, the state of the art of psychologic assessment of the aged is currently rather limited, but the outlook for the near future appears encouraging. In evaluating the condition of a geriatric patient, the clinical psychologist normally generates data through observations, testing, and interviewing. The resulting report covers the following areas: 1) adaptation to the examination and behavioral characteristics during the procedure, 2) cognitive functioning, 3) visual motor coordination and perception of spatial relationships, and 4) personality characteristics and mental health status. Data for the first area are normally derived by the examiner from observations and subjective impressions of the patient's behavior. For each of the other areas the information is obtained through standardized tests. In this discussion, some of the principal assessments that are currently available are reviewed and evaluated for their usefulness with the aged. PMID:6361103
Interest in longitudinal integrated clerkships (LICs) as an alternative to traditional block rotations is growing worldwide. Leaders in medical education and those who seek physician workforce development believe that "educational continuity" affords benefits to medical students and benefits for under-resourced settings. The model has been recognized as effective for advancing student learning of science and clinical practice, enhancing the development of students' professional role, and supporting workforce goals such as retaining students for primary care and rural and remote practice. Education leaders have created multiple models of LICs to address these and other educational and health system imperatives. This article compares three successful longitudinal integrated clinical education programs with attention to the case for change, the principles that underpin the educational design, the structure of the models, and outcome data from these educational redesign efforts. By translating principles of the learning sciences into educational redesign efforts, LICs address the call to improve medical student learning and potential and advance the systems in which they will work as doctors. PMID:22746961
An awareness of the journey's destination and the consequential events along the way will better enhance our diagnoses and in turn sustain our elder "homo turisticus," no longer an endangered species but worthy of our continued compassionate care while enjoying their longevity. All potential treacheries must be assessed by each elderly traveler. It may be the first of many trips or the last opportunity to view and relate to the sequoia's longevity, hike the Scottish highlands, view the game of the Serengeti, explore the Nordic fjords, indulge in the Patagonian scenes of the Iguazú falls, seek the habitats of the Galápagos tortoise, partake of the photograph opportunities of Papua-New Guinea, or finalize that "last" business contract in the Orient. With consideration of these many vulnerabilities and potential hazards, why then undertake the journey? Perhaps our geriatric globetrotters give credence to the age-old saying (of unknown origin) "Running water never freezes." PMID:1855161
Vitamin B12 is an important area in the interface between geriatrics and hematology. B12 deficiency is more common in the elderly and because its neurologic manifestations overlap very common disorders such as dementia, the diagnosis may be more subtle in the elderly. The critical question is whether early treatment of B12 deficiency can prevent some cases of dementia. If prevention is possible, then all elderly patients should be screened for cobalamin deficiency. Research must be ongoing to determine the most cost-effective strategy for evaluating low B12 levels. In our view careful review of the blood smear is still very useful. Although requiring further study, the Herbert/Herzlich model should prove to be very useful to the clinician evaluating patients for possible B12 deficiency. Finally, although the treatment is lifelong, we would argue that when in doubt the patient should be treated. The cost of therapy is small when balanced against the potential consequences. PMID:2511717
Geriatric wards have a higher prevalence of infection than surgical or acute medical wards, and multiresistant organisms contribute a nonnegligeable proportion of infections in elderly inpatients. The measures used to prevent nosocomial infections in geriatric wards are the same as in other types of wards. They include identifying and ensuring the technical and geographic isolation of colonized and infected patients. Health care providers should be informed of the situation, and antimicrobials used with discernment to avoid the selection of multiresistant organisms. Implementation of these measures is made difficult by architectural factors, the fact that many geriatric patients require assistance in all the activities of daily living, and the long duration of stays in geriatric wards. Additional measures are probably essential to achieve long-term control of nosocomial infections. Insufficient attention has been given to health care providers' perceptions of nosocomial infection and to defining the tasks actually performed by these providers. PMID:9769907
Text Version... younger patients to drug therapy in a ... geriatric patients using concomitant therapies and with co ... population, eg, effects on cognitive function, balance ... More results from www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation
Objective To evaluate the effect of specialist geriatric medical management on the outcomes of at risk older people discharged from acute medical assessment units. Design Individual patient randomised controlled trial comparing intervention with usual care. Setting Two hospitals in Nottingham and Leicester, UK. Participants 433 patients aged 70 or over who were discharged within 72 hours of attending an acute medical assessment unit and at risk of decline as indicated by a score of at least 2 on the Identification of Seniors At Risk tool. Intervention Assessment made on the acute medical assessment unit and further outpatient management by specialist physicians in geriatricmedicine, including advice and support to primary care services. Main outcome measures The primary outcome was the number of days spent at home (for those admitted from home) or days spent in the same care home (if admitted from a care home) in the 90 days after randomisation. Secondary outcomes were determined at 90 days and included mortality, institutionalisation, dependency, mental wellbeing, quality of life, and health and social care resource use. Results The two groups were well matched for baseline characteristics, and withdrawal rates were similar in both groups (5%). Mean days at home over 90 days’ follow-up were 80.2 days in the control group and 79.7 in the intervention group. The 95% confidence interval for the difference in means was ?4.6 to 3.6 days (P=0.31). No significant differences were found for any of the secondary outcomes. Conclusions This specialist geriatric medical intervention applied to an at risk population of older people attending and being discharged from acute medical units had no effect on patients’ outcomes or subsequent use of secondary care or long term care.
Objective: To evaluate the rehabilitation programme in a geriatric day hospital.Design: An observational study.Setting: An urban geriatric rehabilitation day hospital.Subjects: Three hundred and fifty-three older patients admitted to a rehabilitation day hospital during 2000: 163 post stroke, 113 with deconditioning and 77 post orthopaedic surgery (hip fracture and joint replacement).Main outcome measures: Functional Independence Measure (FIM), Nottingham Extended ADL Index,
Avital Hershkovitz; Daniel Gottlieb; Yichayaou Beloosesky; Shai Brill
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.
A longitudinal clerkship was designed at Harvard Medical School (HMS) in 2004-2005 to emphasize continuity, empathy, learner-centeredness, and patient-centered care. In 2005-2006, the curriculum was piloted with eight students who voluntarily enrolled in the third-year curriculum, which focused on longitudinal mentorship and feedback, interdisciplinary care, integration of clinical and basic science, and humanism in patient care. Eighteen traditional curriculum (TC) students at HMS who were comparable at baseline served as a comparison group. SHELF exams and OSCE performance, monthly and end-of-year surveys, and focus groups provided comparisons between pilot and TC students on their performance, perceptions, attitudes, and satisfaction. Pilot students performed as well as or better than their peers in standardized measures of clinical aptitude. They demonstrated statistically significant greater preservation of patient-centered attitudes compared with declining values for TC students. Pilot students rated the atmosphere of learning, effective integration of basic and clinical sciences, mentorship, feedback, clerkship satisfaction, and end-of-year patient-care preparedness significantly higher than TC students. The authors conclude that implementation of a longitudinal third-year curriculum, with only modest alterations in existing clinical training frameworks, is feasible and effective in meeting its stated goals. "Exposing" the hidden curriculum through specific longitudinal activities may prevent degradation of student attitudes about patient-centered care. Minimizing the disjointed nature of clinical training during a critical time in students' training by providing a cohesive longitudinal curriculum in parallel to clinical clerkships, led by faculty with consistent contact with students, can have positive effects on both professional performance and satisfaction. PMID:18448900
Bell, Sigall K; Krupat, Edward; Fazio, Sara B; Roberts, David H; Schwartzstein, Richard M
The New York University School of Medicine has a rich tradition of cultivating programs in medical humanities and professionalism. They are drawn from the departments, centers, students, and faculty in the School of Medicine, have linkages throughout the university, and are interwoven into the fabric and culture of the institution. Some are centrally based in the School of Medicine's deans' office, and others are located in individual departments and receive support from the dean's office. This article describes representative programs for medical students and faculty. Curricular initiatives, the fundamental components of medical students' learning, include a course entitled "The Physician, Patient, and Society," a clerkship essay in the MedicineClerkship, an opportunity for reflection during the medicineclerkship, and a medical humanities elective. In 2002, the Professionalism Initiative was launched to enhance and reflect the values of the medical profession. Its curriculum consists of a series of events that coordinate, particularly, with existing elements of the first-year curriculum (e.g., orientation week, a session during anatomy, a self-assessment workshop, and a peer-assessment workshop). The Master Scholars Program is a group of five, theme-based master societies consisting of faculty and students who share common interests around the society's themes. Programs developed for the societies include colloquia, faculty-led seminars, a mandatory student-mentoring program, and visiting scholars. Finally, the authors describe three high-quality literary publications created at New York University School of Medicine. Each of the initiatives undergoes regular critical examination and reflection that drive future planning. PMID:14534091
Rehabilitation medicine is the medical specialty that integrates rehabilitation as its core therapeutic modality in disability management. More than a billion people worldwide are disabled, and the World Health Organization has developed the International Classification of Functioning, Disability and Health as a framework through which disability is addressed. Herein, we explore paradigm shifts in neurorehabilitation, with a focus on restoration, and provide overviews on developments in neuropharmacology, rehabilitation robotics, virtual reality, constraint-induced therapy and brain stimulation. We also discuss important issues in rehabilitation systems of care, including integrated care pathways, very early rehabilitation, early supported discharge and telerehabilitation. Finally, we highlight major new fields of rehabilitation such as spasticity management, frailty and geriatric rehabilitation, intensive care and cancer rehabilitation. PMID:24154577
Ng, Y S; Chew, E; Samuel, G S; Tan, Y L; Kong, K H
Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU) where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors) and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care, but also improved staff knowledge and satisfaction. The model may then be transposed across various locations and disciplines in the acute hospital where delirious patients could be sited. Trial Registration Current Controlled Trials ISRCTN52323811
A geriatric study was conducted on 213 institutionalized geriatric glaucoma patients (mean age 83.9 years) and 100 control patients (mean age 81.3 years). A 12-lead electrocardiogram (ECG) analyzed according to the Minnesota code was recorded for 212 glaucoma patients and 95 control patients. The most frequent finding (in 56% of the glaucoma patients and in 38% of the control patients, P less than 0.05) was a negative or isoelectric T-wave, suggestive of ischemic heart disease. ECG findings suggestive of coronary heart disease (Q/QS patterns, ST-segment depression, negative or isoelectric T-wave, third or second degree AV block, left bundle branch block or right bundle branch block, intraventricular block or atrial fibrillation or flutter) was seen significantly more often in glaucoma patients (164/212; 77%) than in the control patients (59/95; 62%). Seventeen percent of the glaucoma patients had atrial fibrillation (AF), which was significantly more than for the control group (8/95; 8%). There was no difference in the number of ECG changes between patients with bilateral open-angle glaucoma and bilateral angle-closure glaucoma. The mean intraocular pressure of patients having AF (15.9 +/- 8 mmHg) was significantly lower than that of the other patients (18.4 +/- 11 mmHg) (P less than 0.05). Fifty-five glaucoma patients were considered blind (visual acuity less than 0.05 in the better eye). The visual acuity of patients having AF was lower than that of the other patients, and severe visual field defects (arcuate scotoma or a residual field in the temporal periphery) occurred, slightly more frequently in patients with AF (in 70% vs 51% of the other patients). Arrhythmias, especially AF, are connected with impairment of visual acuity and visual field defects in glaucoma patients. The result of this retrospective study indicate that ECG changes occur frequently, suggesting coronary heart disease in elderly glaucoma patients. PMID:1597283
Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99 +/- 2.44 years and the weight was 19.64 +/- 15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing's disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of anaesthetic practice but it is an appropriate time to perform such an evaluation. The value of pre-anaesthetic screening in veterinary anaesthesia still needs to be evaluated in terms of appropriate outcome variables. PMID:17665763
The Geriatrics and Gerontology Advisory Committee, established in 1981 under the Veterans Administration Health Care Amendments of 1980, is responsible for advising the VA Chief Medical Director on all matters pertaining to geriatrics and gerontology; for...
|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)…
Biological aging means a time-dependent accumulation of changes to which a living organism is being exposed during its lifetime. Biological aging normally concurs with chronological aging the time frame of which is set by an upper limit, the lifespan (in humans approximately 120 years). New findings in experimental biogerontology are challenging both the dogma of irreversibility of biological aging and the preset species-specific limitations of life. The present overview first explains the general principle of rejuvenation and reversal of biological aging with paradigms from stem cell research. Secondly, recent key publications on artificial telomerase elongation and (alleged) lifespan enhancement by sirtuins and resveratrol will be discussed with an emphasis on the implications for (future) geriatricmedicine. PMID:23242337
Bollheimer, L C; Volkert, D; Bertsch, T; Sieber, C C; Büttner, R
BACKGROUND: Effective stroke intervention and risk reduction depend on the general public's awareness and knowledge of stroke. In Korea, where both traditional Oriental medicine and Western medicine are practiced, estimates of the general public's awareness and knowledge of stroke are poor. The present study sought to describe the inception cohort of the Ansan Geriatric Study (AGE study) and to determine
Moon Ho Park; Sangmee Ahn Jo; Inho Jo; Eunkyung Kim; Su-Yong Eun; Changsu Han; Min Kyu Park
|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…
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 group of Filipino geriatric nurses
Allan B. de Guzman; Rona Denise V. Coronel; Kannerin O. Chua; Mariz G. Constantino; Ericsann James C. Cordova
In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational programme aims at an increase in dentists serving in geriatric care who are well prepared for delivering
This study investigated the effectiveness of a multiyear geriatric interdisciplinary team training (ITT) program conducted by a geriatric education center in cooperation with three large health care systems. Approximately 40 half-day training sessions were planned and implemented by the university-community partnership. The training sessions included core content on team processes and substantive clinical material on geriatric concerns and disease states
Constance L. Coogle; Iris A. Parham; J. James Cotter; E. Ayn Welleford; F. Ellen Netting
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…
Ivry, Joann; Lawrance, Frances P.; Damron-Rodriguez, JoAnn; Robbins, Virginia Cooke
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,…
Apolipoprotein E (APOE) has been associated with a variety of late-life neuropsychiatric disorders, including geriatric depression. This study determined whether APOE genotypes affect vulnerability to geriatric depression. We also tested the effect of the presence of the APOE ε4 (APOE4) allele on age of onset, suicide attempt history and cognitive function in geriatric depressed patients. We genotyped APOE in 111
Satellite teleconferencing offers unique opportunities to bring together geographically dispersed groups for educational purposes. For Geriatric Education Centers with a federal mandate to train large numbers of faculty and practicing health professionals in geriatrics, teleconferencing has been a particularly appropriate vehicle for delivery of educational programming. For a 7?year period, 1985?1992, the Virginia Geriatric Education Center (VGEC) developed and broadcast
Background: The assessment of the older driver is a signif- icant challenge in geriatric care. Most studies of older dri- vers have focused on the outpatient assessment of driving safety. Inpatient geriatric rehabilitation units may provide an opportunity for the identification and assessment of the high-risk older driver. Methods: Charts of all patients admitted to a Geriatric Inpatient Unit (GIU)
Frailty is associated with an increased risk of depressive syndromes. This review aims to summarize data on coincidence, clinical presentation, and diagnostic and therapeutic work-up of depression in frail patients. Depressive syndromes in geriatric patients are characterized by increased frequency and intensity of somatic symptoms. There is considerable overlap with symptoms of frailty. Both syndromes indicate an increased risk for subsequent somatic morbidity, worsening depression functional deterioration, admission to a nursing home and mortality. Diagnosis of subthreshold depressive syndromes allows preventive measures to be initiated. Barrier-free access to preventive and therapeutic interventions is essential. Concomitant somatic symptoms in subthreshold depression increase risk of progression to major depression. They must be addressed in an interdisciplinary approach involving geriatric teams and geriatric psychiatry. PMID:23250310
|The effectiveness of various procedures in maintaining attendance at activities of residents at a geriatric facility was examined. A special, intermittently programmed or delayed consequence for attendance was added to regularly scheduled activities. Attendance at activities with and without the consequence was compared. Later, antecedent events…
The number of hospitalized older adults in Portugal necessitates a better understanding of the acute care environment for older adults. This study translated and examined the psychometric qualities of the Geriatric Care Environment Scale (GCES) among 1,068 Portuguese registered nurses (RNs). Four factors emerged from the exploratory factor analyses: resource availability, aging-sensitive care delivery, institutional values regarding older adults and staff, and continuity of care. The internal consistency of the GCES was ? = .919. The GCES was significantly associated with the variables of region, hospital type, unit type, and RNs perception of hospital educational, staff knowledge, difficulty, rewarding, and burdensome in caring for older adults. Nurses who worked in hospitals centers in the northern region and medical and surgery units had more positive perceptions of the geriatric care environment. More positive perception was also found among RNs that reported more educational support, had more knowledge, and felt more rewarding and less difficulty and burden in caring older adults. This process resulted in a valid and reliable measurement of the geriatric care environment Portuguese version which provides hospital leadership with an instrument to evaluate organizational support for geriatric nursing practice and target specific areas that support or hinder care delivery. PMID:23781244
Paulo de Almeida Tavares, João; Leite da Silva, Alcione; Sá-Couto, Pedro; Boltz, Marie; Capezuti, Elizabeth
An approach to curriculum design for geriatric dentistry that incorporates an understanding of the students' own developmental stages into instructional activities is outlined, and the University of Mississippi's experience with this strategy is evaluated. An important element is to help students crystallize their value systems with regard to the…
This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric…
|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…
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…
The number of hospitalized older adults in Portugal necessitates a better understanding of the acute care environment for older adults. This study translated and examined the psychometric qualities of the Geriatric Care Environment Scale (GCES) among 1,068 Portuguese registered nurses (RNs). Four factors emerged from the exploratory factor analyses: resource availability, aging-sensitive care delivery, institutional values regarding older adults and staff, and continuity of care. The internal consistency of the GCES was ? = .919. The GCES was significantly associated with the variables of region, hospital type, unit type, and RNs perception of hospital educational, staff knowledge, difficulty, rewarding, and burdensome in caring for older adults. Nurses who worked in hospitals centers in the northern region and medical and surgery units had more positive perceptions of the geriatric care environment. More positive perception was also found among RNs that reported more educational support, had more knowledge, and felt more rewarding and less difficulty and burden in caring older adults. This process resulted in a valid and reliable measurement of the geriatric care environment Portuguese version which provides hospital leadership with an instrument to evaluate organizational support for geriatric nursing practice and target specific areas that support or hinder care delivery.
Paulo de Almeida Tavares, Joao; Leite da Silva, Alcione; Sa-Couto, Pedro; Boltz, Marie
|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)|
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…
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…
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…
Case management practices have continued to grow despite a lack of clear evidence of their efficacy. With the expanding segment of the elderly population, there is a critical need to develop and identify programs that will address the many needs of the aging. Geriatric Case Management has been the avenue selected by many health care providers to address these issues,
Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person’s privacy. Attending a day centre confers much benefit, but one must understand the old
Trends and issues in geriatric care in the United Kingdom are reviewed, with emphasis on aspects of the British system that have relevance for the United States. In 1973, 13.6 percent of the population of the United Kingdom was over 65 years of age, compa...
|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…
|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…
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
|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…
Since their inception, social work education programs have operated in partnership with community agencies, as both field sites and foci for research. However, surprisingly little has been written on models of university\\/community partnerships in social work or the role of agencies in shaping curricula. This study analyzed the outcome reports of 67 Council on Social Work Education Geriatric Enrichment Projects
|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…
Goins, R. Turner; Gainor, Sara Jane; Pollard, Cecil; Spencer, S. Melinda
With the attenuation of many physiologic and social functions in advancing age, the geriatric population is especially prone to adverse drug reactions. The indications for drug therapy should be re-examined periodically, along with biochemical profiles of renal function, serum electrolytes, and drug plasma levels when available. The dosing of a number of medications should be continuously readjusted according to the
Anticachexic or antisarcopenic medications are pre- scribed worldwide for geriatric patients with poor ap- petite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syn- drome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of
Shing-Shing Yeh; Sherri Lovitt; Michael W. Schuster
The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact,
Kevin Duff; Cynthia C. Spering; Sid E. OBryant; Leigh J. Beglinger; David J. Moser; John D. Bayless; Kennith R. Culp; James W. Mold; Russell L. Adams; James G. Scott
The purpose of this paper is to present an effective approach toward the prevention and rehabilitation of a geriatric population living within a community, in assisted living facilities or in nursing homes. A group-based progressive strength training program can help individuals reach their own personal functional fitness goals and promote future independence, improve balance, coordination, range of motion, flexibility, and
Seven standardized external quality assurance (QA) procedures are currently being applied in geriatric rehabilitation in Germany. Five of these procedures are case-based (Gemidas, GiB-DAT, KODAS, EVA-Reha, Evaluation Procedures of the Medical Review Board of Saxony), and two are institution-based (Quality Seal for Geriatric Rehabilitation in Rhineland-Palatinate, Quality Seal for Geriatrics BAG KGE). The institution-based procedures focus on the quality dimensions "structure" and "process", whereas the case-based procedures mainly focus on the collection of administrative data, and to a limited extent on the quality dimensions "outcomes" and "patient satisfaction". The outcome quality parameters used in the case-based QA procedures are usually the "place of discharge" versus the "place of residence", the "improvement in coping with daily activities" (mostly based on the Barthel Index), and the "improvement in mobility and gait" (based on the Timed Up & Go). So far, outcomes to be specified at the beginning of rehabilitation measures have only been defined in few procedures, and only to a basic degree or on a trial basis. In the institution-based procedures, the data are mainly collected by external data collectors, whereas in the case-based procedures, they are collected by the service providers themselves. In most procedures, data processing and analysis are performed independently of the participating service providers but only partly independently of the agency responsible for the procedure and the whole group of service providers. In the case-based procedures, risk adjustment techniques are not routinely applied in comparisons between institutions. Attempts to implement standardised QA procedures in geriatric rehabilitation may be based on existing procedures and should use this appraisal for developing them further, however taking more into account QA aspects specific to geriatrics. PMID:18247270
Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes. PMID:22376048
The practice of emergency medicine (EM) requires proficient and expert skills in multiple high risk procedures. The emergency physician in-training needs a safe and realistic environment in which to practice and perfect the skills necessary to care for patients ranging from the critically ill to the patient with difficult intravenous access. Undergraduate medical, education overall has a need for training that enables students to develop the knowledge, skills and attitudes to practice in a variety of specialties. This article provides an overview of simulation in a three-year emergency medicine residency at Truman Medical Center, in a required final year clerkship for all medical students at the University of Missouri-Kansas City, and discusses national trends for the use of simulation in emergency medicine. PMID:23724485
Ellison, Stefanie; Sullivan, Christine; McCullough, Robert
BACKGROUND: Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about
Leora Horn; Katina Tzanetos; Kevin Thorpe; Sharon E Straus
The Student Senior Partner Program (SSPP) forms the core of the required medical student geriatrics curriculum at the University of California-Irvine School of Medicine (UCISOM). The program utilizes a longitudinal modular format that extends over the first three years of medical school. Instruction is presented in didactic, patient interactive,…
Fitzpatrick, Camille; Musser, Anne; Mosqueda, Laura; Boker, John; Prislin, Michael
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 Scholarly Concentration in Aging, Schwartz Communication Sessions, a Website of aging-related materials, and a
Richard W. Besdine; Renée R. Shield; Lynn McNicoll; Susan E. Campbell; Terrie Wetle
|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…
Besdine, Richard W.; Shield, Renee R.; McNicoll, Lynn; Campbell, Susan E.; Wetle, Terrie
|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)|
Because of the growing population of older adults in America, nursing faculty throughout the United States have been consistently challenged during the past decade to use the most appropriate methods to strengthen geriatric content in baccalaureate nursing programs. The question of whether to integrate content throughout the curriculum or offer a stand-alone geriatric nursing course has been explored extensively, but no ultimate conclusion has been found. With the support of a grant for geriatric curriculum integration from the John A. Hartford Foundation, one university began the journey to integrate geriatric nursing curriculum throughout all baccalaureate nursing courses. However, at a curriculum evaluation meeting held halfway through the grant period, faculty expressed the need to have concentrated content earlier in the program that could serve as a foundation on which to build geriatric knowledge. Faculty unanimously voted to create a geriatric nursing course to be offered to students during their second year of baccalaureate study. PMID:16021801
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)
ObjectivesTo determine contentment with the performance of primary mission emergency care providers.MethodsA prospective cohort study was conducted using key informant interviews to assess quality of life and self-rated degree of contentment with care in geriatric emergencies.ResultsInterviews concerning a total of 152 geriatric emergency cases in nursing homes were conducted with patients in 13 (8.6%) cases, geriatric nurses in 132 (86.8%)
M. K. Bluemel; C. Traweger; J. F. Kinzl; M. A. Baubin; W. Lederer
The prevalence of sleep complaints increases steadily with age. Studies investigating insomnia among elderly people living\\u000a in geriatric homes, especially among Egyptians, are scarce. This study aimed to determine the prevalence of insomnia symptoms\\u000a among the elderly living in geriatric homes in Alexandria and their correlates. A cross-sectional survey of a representative\\u000a sample of elderly population of geriatric homes in
Mohamed M. Makhlouf; Abla I. Ayoub; Moataz M. Abdel-Fattah
Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age P 65 years) (N ¼ 51), middle-age (age 41-64 years) (N ¼ 263) and young subjects with schizophrenia (age
Mao-Sheng Ran; Meng-Ze Xiang; Yeates Conwell; J. Steven Lamberti; Ming-Sheng Huang; You-He Shan; Xian-Zhang Hua
Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age ?65 years) (N=51), middle-age (age 41–64 years) (N=263) and young subjects with schizophrenia (age 15–40 years) (N=196) in a
Mao-Sheng Ran; Meng-Ze Xiang; Yeates Conwell; J. Steven Lamberti; Ming-Sheng Huang; You-He Shan; Xian-Zhang Hu
For the treatment of geriatric inpatients, the efficacy of a multimodal geriatric intervention based on findings of a comprehensive geriatric assessment has well been established. Therefore, the focus of elderly inpatient care switched to the identification of geriatric patients who have unintended or unscheduled contact to an accident and emergency department. In Germany, a uniform standard on how to correctly identify geriatric patients in such settings has yet to be established.Three medical societies, the Federal Association of Geriatrics ("Bundesverband Geriatrie", BVG), the German Society for Gerontology and Geriatrics ("Deutsche Gesellschaft für Gerontologie und Geriatrie", DGGG) and the German Geriatrics Society ("Deutsche Gesellschaft für Geriatrie", DGG) have reached a consensus on tools and instruments for the identification of geriatric patients in the emergency care setting. Basis of the consensus were the existing scientific evidence and further considerations, especially the applicability of international findings in Germany and feasibility.Three recommendations are made: (1) The use of prognostic indices is not recommended, as prognostic indices appear to be inappropriate to disclose the complex needs of geriatric patients. (2) Comprehensive geriatric assessment is established and effective, but too complex for use in the emergency setting. It is recommended for cases in which information from screening instruments or other sources does not allow a clear decision. (3) Among screening instruments, the Identification of Seniors At Risk (ISAR) screening tool seems to be well established and suitable for screening purposes in Germany. A German adaption is recommended as well as the implementation in settings where no other tools or geriatric expertise are available. PMID:22622678
Thiem, U; Greuel, H W; Reingräber, A; Koch-Gwinner, P; Püllen, R; Heppner, H J; Pfisterer, M
PROBLEM: Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument\\u000a exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialities.\\u000a \\u000a \\u000a METHODS: A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels\\u000a and pilot testing, and administered to 305 residents and fellows at 4 institutions
A USEFUL TECHNIQUE IN GERIATRICS: Older people are at high risk of dehydration. In common practice, oral intakes are often inadequate. Intravenous infusion may be difficult and may generate complications. Hypodermoclysis or subcutaneous infusion is a useful technique for the prevention or cure of moderate dehydration in the older subjects. MANY ADVANTAGES AND FEW RISKS: When it is used correctly (i.e. volume and type of solutions, aseptic conditions) and when its contraindications are respected (i.e. emergency situations), hypodermoclysis is a simple technique that is safe, effective and comfortable. It does not need intensive surveillance and can be used both at home or in an institution, thus avoiding hospitalization of older subjects. A TECHNIQUE THAT SHOULD BE DEVELOPED: The numerous advantages of hypodermoclysis in older patients should encourage its wider use in geriatrics. PMID:10636020
Two different provincial programs for geriatric oral health care are described. Their relevance to the United States requires an understanding of the universal, national hospital (1961), and medical (1971) care programs of Canada and the different sociopolitical philosophy of its people. Ontario's new geriatric preventive dentistry program provides free preventive dental services to elderly residents of collective living centers by province-wide dental public health staff. Although it covers only 7% of Ontario's older population in these centers, initiatives are underway to include other elderly persons and to provide cost subsidization for referred treatment, if required. Since 1973, Alberta has provided, through dentists and denturists in private practice, comprehensive free dental benefits to all residents over 64 years of age. About 38% of eligibles now use the plan annually. Cost escalation per dentist user has been quite modest but less so for denturist users. The future of these two models and the problems associated with them are discussed. PMID:10291235
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
Casado Verdejo, Inés; Iglesias Guerra, José Antonio
The aging of the US population will have a major effect on the future practice of pharmacy. By 2030, 20% of Americans will be aged 65 years and older, an increase from 12.4% in 2000.1 A challenge to colleges and schools of pharmacy in the 21st century is to prepare students and practitioners to meet the growing pharmaceutical care needs of the older adult population and to meet these needs in a variety of care settings. This paper reviews the present state of geriatric pharmacy education and training, including strategies for ensuring that practicing pharmacists will have adequate knowledge, skills, attitudes, and values to provide this care. Secondly, this report provides strategic directions and recommendations for successfully implementing geriatrics curricula at an institutional level
Breslow, Robert M.; Koronkowski, Michael J.; Williams, Bradley R.; Hudgins, Gayle A.
BACKGROUND:The overall suicide rate increases both with age and illness. Older hospitalized persons may be most at risk for silent suicide.OBJECTIVE:This study sought to determine whether nurses noted the signs of silent suicide in the medical records of elderly depressed hospitalized patients.STUDY DESIGN:This exploratory study included a retrospective chart review of geriatric patients who were identified as clinically depressed. Review
This thesis deals with accidents happening in usual care regarding medication use. The evaluation of polypharmacy during geriatric assessment is described. Finally, the di-lemmas in the treatment of frequently present cardiovas-cular diseases are discussed. In chapter 1.1 a case report is presented about dirt in a fax machine causing a grey stripe on a faxed prescription of trazodone. This obliterated
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
Bartels, Stephen J; Dums, Aricca R; Oxman, Thomas E; Schneider, Lon S; Areán, Patricia A; Alexopoulos, George S; Jeste, Dilip V
A 52-year-old geriatric nurse presented with recurrent eczema localized in uncovered skin areas. Patch testing produced an eczematous skin reaction with type IV sensitization totetrazepam. A relapse of contact dermatitis was successfully prevented by using occupational skin protection measures and organizational measures.Our case indicates that a sensitization to drugs should be considered when allergic contact dermatitisis suspected in nursing personnel. PMID:19453384
Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture\\u000a surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve\\u000a than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high.\\u000a Multidisciplinary care, including early orthogeriatric input,
D. Marsland; P. L. Colvin; S. C. Mears; S. L. Kates
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.
Shahar, Suzana; Chee, Kan Yin; Wan Chik, Wan Chak Pa'
Our new lessons of nurturing life to make happiness and well-being of geriatric patients suggest comprise several important steps. First, geriatric patient care should not be delegated to specialists who focus on individual organ system. Instead, we should respond to the patient's condition based on comprehensive assessment to identify the single pathogenesis. Second, we should appreciate that the behavioral and psychological symptoms of dementia (BPSD) often reflect the behavioral and psychological symptoms of the caregiver (BPSC), and in particular the caregiver's attitude. Third, pleasant stimulations to the limbic system should receive more emphasis than attempting brain training in atrophied portions of the neocortex. Fourth, we should aim not for "successful aging," but for "balanced aging." Fifth, we should rely less on drug-based therapy and utilize more non-pharmacologic approaches to appropriate therapy. Geriatric patients should be cared for based on our new lessons of nurturing life rather than the heavily medicalized treatment modalities that are in wide use today. PMID:22790875
Butler, James P; Fujii, Masahiko; Sasaki, Hidetada
To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients with hip fractures, we reviewed the charts of all patients aged 60 years or older who were treated for hip fractures in five hospitals in Hamilton, Ont., between August 1982 and September 1983. We hypothesized that discharge to a different location from that before admission would indicate reduced functional status and classified the reasons for a change in residence as poor patient motivation, need for rehabilitation, compromised ambulation, postoperative complications and inevitable deterioration. We believed that geriatric care would be most beneficial to those in the first three groups. Of the 327 patients with hip fractures 40 (12%) died before discharge. Of the 287 surviving patients 149 (52%) had been discharged by 4 weeks, and only 29 (10%) remained in hospital by 12 weeks. Of the 287, 44 (15%) were discharged to a different location from that before admission: in 75% the cause appeared to be inevitable deterioration (57%) or postoperative complications (18%). The remaining 25% needed rehabilitation and were all sent to appropriate facilities. None of the patients with ambulation problems or poor motivation required an increased level of care. We could not show a need for geriatric care in our population; possible explanations are discussed. PMID:3730998
Wilson, D B; Turpie, I D; Patterson, C J; Cino, P M; Guyatt, G H
Nonhuman primates are frequently used for aging studies. We observed a high prevalence of skin disease among a group of geriatric rhesus monkeys (mean age = 25 years; n = 9) used in aging behavioral studies. Gross and histopathologic changes in the skin of these geriatric rhesus were compared with skin from control adult monkeys (mean age = 10; n = 4) and sun-exposed monkeys (mean age = 11; n = 4) to characterize age-related skin changes. Biopsy specimens were taken from four specified skin locations (lateral to bridge of nose, ventral midline, dorsal midline, perineal area) and from additional areas where skin lesions were present. Samples were routinely processed and evaluated by light microscopy. Blood samples were collected and tested for estrogen, thyroid-stimulating hormone, triiodothyronine thyroxine, and cortisol levels. The axilla was swabbed and samples were obtained for bacterial culturing. All nine of the geriatric monkeys had notable dermal lesions, while one of the control monkeys and one of the sun-exposed monkeys had abnormal findings. Major gross findings included increased areas of erythematous skin, wrinkling, focal skin scaling, thinning of hair, foot calluses, and exudative lesions. Histologic skin changes included subacute dermatitis, acanthotic dermatitis, and a lesion resembling an early solar lentigo in the sun-exposed animal. These changes were not associated with hormonal abnormalities or bacterial pathogens. Histologic changes are compatible with nonspecific skin changes observed in elderly humans. This study establishes a baseline of dermatologic changes of the aging rhesus macaque. PMID:9210025
Huneke, R B; Foltz, C J; VandeWoude, S; Mandrell, T D; Garman, R H
Sixty-four urban children grades K-6 were interviewed in an exploratory study in 1980 to provide information about children's knowledge and orientations toward medicines and abusable substances. Responses indicated children believe themselves to have considerable autonomy in medicine use — 72% said they ask for medicines, 67% get medicines for themselves and others, and 19% (more often older and less economically
The Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation published geriatrics competencies for medical students in 2008 defining specific knowledge and skills that medical students should be able to demonstrate before graduation. Medical schools, often with limited geriatrics faculty resources, face challenges in teaching and assessing these competencies. As an initial step to facilitate more-efficient implementation of the competencies, a 1-week geriatrics rotation was developed for the third year using clinical, community, and self-directed learning resources. The Wake Forest University School of Medicine Acute Care for the Elderly Unit serves as home base, and each student selects a half-day outpatient or long-term care experience. Students also perform a home-based falls-risk assessment with a Meals-on-Wheels client. The objectives for the rotation include 20 of the 26 individual AAMC competencies and specific measurable tracking tasks for seven individual competencies. In the evaluation phase, 118 students completed the rotation. Feedback was positive, with an average rating of 7.1 (1 = worst, 10 = best). Students completed a 23-item pre- and post-knowledge test, and average percentage correct improved by 15% (P < .001); this improvement persisted at graduation (2 years after the pretest). On a 12-item survey of attitudes toward older adults, improvement was observed immediately after the rotation that did not persist at graduation. Ninety-seven percent of students documented completion of the competency-based tasks. This article provides details of development, structure, evaluation, and lessons learned that will be useful for other institutions considering a brief, concentrated geriatrics experience in the third year of medical school. PMID:23710572
Atkinson, Hal H; Lambros, Ann; Davis, Brooke R; Lawlor, Janice S; Lovato, James; Sink, Kaycee M; Demons, Jamehl L; Lyles, Mary F; Watkins, Franklin S; Callahan, Kathryn E; Williamson, Jeff D
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
Corcoran, Amy M; True, Gala; Charles, Natasha; Margo, Katherine L
Evidence-based practice holds tremendous potential to optimize care outcomes for older adults, yet many nurses are ill prepared to identify, interpret, and apply the best evidence to their practice. The Geriatric Nursing Innovations through Education (GNIE) Institute is a 39-contact-hour, hybrid distance learning continuing education model designed to strengthen RNs'clinical knowledge, leadership skills, and capacity for implementing evidence-based geriatric care. The GNIE Institute combines reflective, learner-centered instructional approaches with a practicum during which evidence-based guidelines are implemented.The experiences of 128 RNs suggest that the GNIE Institute supports the implementation of a variety of best practices, including management of acute pain, dehydration, delirium, oral hygiene, urinary incontinence, and falls prevention. Participant feedback has shown low initial awareness of practice guidelines but high satisfaction with their use. The GNIE Institute thus represents a viable model for building the capacity of practicing RNs to implement evidence-based approaches to the care of geriatric syndromes across the care continuum. PMID:19452736
McConnell, Eleanor S; Lekan, Deborah; Bunn, Melanie; Egerton, Emily; Corazzini, Kirsten N; Hendrix, Cristina D; Bailey, Donald E
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…
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.
Background: Fall incidents and their negative outcomes represent a considerable problem in hospitals, especially in geriatric wards, and require implementation of strategies to prevent these undesirable events. For this reason, the College of Geriatrics, a body funded by the Belgian Government to set up quality improvement initiatives in geriatric wards, selected ‘Fall prevention in Belgian hospitals’ as a quality project
Joke Coussement; Eddy Dejaeger; Margareta Lambert; Nele Van Den Noortgate; Leen De Paepe; Steven Boonen; Didier Schoevaerdts; Koen Milisen
|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…
de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.
Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the “lebenswelt” that describe the
Allan B. de Guzman; Reena-Jane D. Dangoy; Kathleen Christian V. David; Ken Jarrett H. Dayo; Keisha A. de Claro; Giorgio von Gerri G. de Guzman; Gerald Ian D. de Jesus
BACKGROUND: Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored
Marianne Mesteig; Jorunn L Helbostad; Olav Sletvold; Tove Røsstad; Ingvild Saltvedt
|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…
de Guzman, Allan B.; Coronel, Rona Denise V.; Chua, Kannerin O.; Constantino, Mariz G.; Cordova, Ericsann James C.
Background: There is a lack of studies concerning improvement of medication use in palliative care patients in nursing homes.Objective: This study was conducted to evaluate whether a geriatric palliative care team reduced unnecessary medication prescribing for elderly veterans residing in a nursing home.Methods: This was a retrospective, descriptive study of patients who died while residing in a geriatric palliative care
Erin M. Suhrie; Joseph T. Hanlon; Emily J. Jaffe; Mary Ann Sevick; Christine M. Ruby; Sherrie L. Aspinall
In 2007, the Health Resources Services Administration (HRSA) introduced new mandates which raised the standards on program evaluation for Geriatric Education Centers. Described in this paper are the primary and secondary evaluation efforts undertaken for one program within the XX Geriatric Education Center (XXGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the
|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…
Current guidelines for implantable cardioverter-defibrillator (ICD) therapy in heart failure patients were established by multiple device trials; however, very few geriatric patients (patients ? 65 years old) were included in these studies. This article explores the controversies of ICD implantation in the geriatric population, management of delivered ICD therapy in this age group, and the end of life care in patients with ICD.
|Reality Orientation (RO) Therapy, a recently developed mode of treatment for use with geriatric patients was discussed. A controlled study was conducted comparing the effects of RO with those of traditional hospital care. The results indicated that RO is a promising technique for use with a chronic geriatric patient population. (Author)|
As the elderly population increases and they lead more active and healthy lifestyles, their exposure to the threats of injury multiply. Undoubtedly, the geriatric population will comprise a growing percentage of trauma patients. The role of alcohol and drug use in geriatric trauma has not been clearly defined. The purpose of this study is to determine the incidence of alcohol
John L. Zautcke; Steven B. Coker; Ralph W. Morris; Leslee Stein-Spencer
|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…
Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.
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…
Price, Rachel M.; Alkema, Gretchen E.; Frank, Janet C.
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…
Williams, Brent C.; Schigelone, Amy R.; Fitzgerald, James T.; Halter, Jeffrey B.
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…
Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.
Changing U.S. demographics and family composition are challenging social work education programs to reposition and reconsider how to prepare students for practice in the field of geriatrics. Implications for future social service and health care needs include ongoing training and education of students with competencies in serving geriatric…
Behrman, Gary; Mancini, Michael; Briar-Lawson, Katharine; Rizzo, Victoria M.; Baskind, Frank; Valentine, Carl
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…
Laditka, Sarah B.; Jenkins, Carol L.; Eleazer, G. Paul; Kelsey, Susan G.
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,…
Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles. PMID:23379444
The team approach to geriatric care does not automatically result in appropriate decision making with regard to elderly patients with multiple chronic problems and complicated, overlapping needs. In this article, Janis's (1972, 1982) group?think theory and tests of facets of the theory are examined. A modified theory is then applied to geriatric health care teams using a case scenario. Suggestions
Gloria D. Heinemann; Michael P. Farrell; Madeline H. Schmitt
Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters.Among elderly patients aged 65 or over
Hirono Ishikawa; Debra L. Roter; Yoshihiko Yamazaki; Tomoko Takayama
|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.…
In this article, the authors take a systematic look at transaction costs and barriers to a university-community partnership during the design and implementation of a Geriatric Interdisciplinary Team Training Certificate. The development of the authors’ university-community partnership was fueled by a funding source that enabled the Virginia Geriatric Education Center to work with three large health care systems. The purpose
E. Ayn Welleford; Iris A. Parham; Constance L. Coogle; F. Ellen Netting; Leigh Peyton Burke; Peter A. Boling
BACKGROUND: Physicians caring for elderly people encounter death and dying more frequently than their colleagues in most other disciplines. Therefore we sought to examine the end-of-life content in popular geriatric textbooks and determine their usefulness in helping geriatricians manage patients at the end of their lives. METHODS: Five popular geriatric textbooks were chosen. Chapters on Alzheimer's disease, stroke, chronic heart
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…
The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. The article includes a definition of "geriatric rehabilitation" in light of the SGB IX, describes the benefit carriers' obligations as well as the procedure in place for determining geriatric rehab need, in this context appraising the designation as "geriatric patient" in terms of its appropriateness as an identifying criterion in determining need. Provision of geriatric rehab benefits is contingent on a potential for attaining rehab goals as specified by SGB IX as well as on fulfillment of the benefit prerequisites. Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care. PMID:17955397
|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…
To which idea of truth may medicine refer? Evidence-based medicine (EBM) is rooted in the scientific truth. To explain the meaning and to trace the evolution of scientific truth, this article outlines the history of the Scientific Revolution and of the parable of Modernity, up to the arrival of pragmatism and hermeneutics. Here, the concept of truth becomes somehow discomfiting and the momentum leans towards the integration of different points of view. The fuzzy set theory for the definition of disease, as well as the shift from disease to syndrome (which has operational relevance for geriatrics), seems to refer to a more complex perspective on knowledge, albeit one that is less defined as compared to the nosology in use. Supporters of narrative medicine seek the truth in the interpretation of the patients' stories, and take advantage of the medical humanities to find the truth in words, feelings and contact with the patients. Hence, it is possible to mention the parresia, which is the frank communication espoused by stoicism and epicureanism, a technical and ethical quality which allows one to care in the proper way, a true discourse for one's own moral stance. Meanwhile, EBM and narrative medicine are converging towards a point at which medicine is considered a practical knowledge. It is the perspective of complexity that as a zeitgeist explains these multiple instances and proposes multiplicity and uncertainty as key referents for the truth and the practice of medicine. PMID:19725478
Diabetes means your blood glucose, or blood sugar, levels are too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends ...
Geriatric health care has become a major issue worldwide. There are no data regarding geriatric dermatologic diseases are available from Nepal. Patients of 60 years and above were enrolled in the Nepali fiscal year 2067(April 2010-April 2011). The data included age, sex, place, and diagnosis. The aim of the study is to determine the characteristic pattern and frequency of dermatoses in dermatologic patients aged 60 years and above. There were total of 6442 patients who visited out patients department. Out of which frequency of geriatric patients were 330, which constitute about 5.1%. The male to female ratio was 50% each. The most common cutaneous dermatoses was eczema 35.8%, fungal infection 13.6%, viral infection 7%, followed by pruritus 7.3%, scabies and photodermatitis 4.5% each, Inflammatory papulosquamous disorder 3.3%, Bacterial infection and Icthyosis 2.1% each, vesiculobullous 1.8%, tumors and pigmentary disorder 0.6% and Miscellaneous group (keratoderma, callus, urticaria, diabetic ulcer, burgers disease, burning feet syndrome, Rosacea, Drug rash-amoxicillin, senile acne, prurigo nodularis, hansens disease, pellagra, Actinic cheilitis) 15.8%. Few patients had more than one dermatoses which constitute < 1% .Photodermatitis was found to be statistically significant. The most common dermatoses were Eczema in females followed by Photodermatitis and comparatively in males viral and fungal infections were common. This study depicts various characteristic patterns of dermatoses seen in elderly. Eczema and infections was found to be most common diseases seen in elderly. Further epidemiologic studies including treatment, follow-up of elderly patients has to be carried out to know the burden of the disease and decrease morbidity and psychological concern associated with diseases. PMID:24047013
Background: Stress has negative effect on health and type 2 diabetes patients may be at an increased risk. Abnormally high levels of free radicals and the simultaneous decline of antioxidant defense mechanisms can increase lipid peroxidation and insulin resistance. The objective of the present study was to demonstrate the efficacy of yogic practice in geriatric patients with type 2 diabetes mellitus and also to compare the efficacy with the state of glycaemic control. Materials and Methods: Seventy three (73) healthy elderly patients of type 2 diabetes mellitus in the age group of 60 to 70 years with a history of diabetes for 5 to 10 years and with poor glycaemic control (HbA1c >8 %) residing in Kozhikode district were recruited for the study. The subjects were divided into three groups according to their glycaemic control. Group I with HbA1c 8.6–9.7 %, group II with HbA1c 9.8–10.7 % and group III with HbA1c 10.8–12.7 %. Participants did yogic practice under the supervision of experienced trainer, daily 90 minutes and for three months. Biochemical estimation of HbA1c, glucose, lipid profile, cortisol, ferritin, malondialdehyde (MDA) and catalase activity were carried out on 0 day and 90th day. Seventy patients participated in a comparable control session. Results: The participants in the test group showed statistically significant (P < 0.001) decrease in glucose, HbA1c, lipids, cortisol, ferritin, MDA and significant increase in catalase activity after yogic practice. Conclusions: Yoga may improve risk profiles induced by stress in geriatric patients with type 2 diabetes and may have promise for the prevention or delay in diabetes complications. And at all stages of the disease a significant improvement can be achieved by yogic practice in geriatric diabetes.
Mitochondrial medicine represents a complex of clinical, biochemical, pathological and genetic information crucial in diagnosis\\u000a and treatment. An outline of the development of mitochondrial medicine was for the first time published by Luft in 1994 .\\u000a Several organizations are focused on mitochondrial medicine, from experimental and clinical research (Mitochondrial Research\\u000a Society – MRS) to patients application (Mitochondrial Medicine Society –MMS),
|Described as a survival manual for Indian women in medicine, this collected work contains diverse pieces offering inspiration and practical advice for Indian women pursuing or considering careers in medicine. Introductory material includes two legends symbolizing the Medicine or Spirit Woman's role in Indian culture and an overview of Indians…
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.
Dramatic demographic changes longevity and medical progress helped create a new population made up of the survivors of previously fatal diseases. These trends pose new major social and economic challenges that should be accounted for in health policy making. This paper discusses the similarities between the specialties of pediatrics and geriatrics, especially in the realm of patient care. Children and the elderly share a limited autonomy and dependence on the human environment (i.e., willing and able caregiving persons) due to age or disease. The long-term care of dependent patients (DP) requires caregiving persons who share with dependent persons the risk of losing autonomy, facing burnout, family disruption, and interference with work and educational activities. Families with DPs may face potential losses of income because both patients and caregivers are partially or completely unable to work, the former for medical reasons and the latter due to the new demands on their time and energy. Additionally, new expenses have to be met because while direct medical expenses might be covered by insurance or the State, other expenses have to be financed by the family, such as co-payments for medicines, new water or electricity home installations, and transport and eventual hotel costs if they have to stay overnight near a hospital outside of their town. The main objectives of long-term care should be to maximize patients' independence and prevent their physical and psychological deterioration while minimizing the social, economic and personal costs to caregivers. To achieve these goals, one needs a holistic approach, a multidisciplinary professional team (doctors, nurses, social workers, nutritionists and psychologists) and auxiliary staff (secretaries, electricians, administrators, messengers, cleaning staff, doormen, nursing aids and coordinators of medical appointments and medical procedures). Optimal management of DPs on chronic treatments such as chronic dialysis requires adequate communication skills, respectful attitudes toward patients and caregivers and effective use of communication and information technologies. Auxiliary personnel require specific training to contribute effectively to the DP attention processes. This paper postulates that pediatric and geriatric teams and their patients would benefit from closer training and sharing of experiences and systems. PMID:19517264
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).
Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students' knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students' prerotation test scores had an average of 64% (95% confidence interval [CI], 61-66%). The postrotation test scores improved to an average of 82% (95% CI, 80-83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1-9; 95% CI, 7.3-9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5-9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6-9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.
Zaorsky, Nicholas G.; Malatesta, Theresa M.; Den, Robert B.; Wuthrick, Evan; Ahn, Peter H.; Werner-Wasik, Maria; Shi, Wenyin; Dicker, Adam P.; Anne, P. Rani; Bar-Ad, Voichita [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Showalter, Timothy N., E-mail: firstname.lastname@example.org [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)
An analysis is presented of a geriatric evaluation unit (GEU) established at the Sepulveda VA Medical Center in 1979 to provide comprehensive interdisciplinary assessment and treatment of geriatric inpatients. The data on 74 patients admitted during the first year show that major improvements can occur in several outcome areas. Placement location was improved over expectations in 48.4 percent of patients, thus permitting a higher level of independence with a lower level of care requirements. Functional status (Katz ADL scale) improved in two-thirds of the patients who could have shown improvement. An average of almost four new treatable disorders not noted by previous physicians were diagnosed per patient. The mean daily number of prescribed drugs was reduced by 32 percent per patient, and the total number of drug doses by 43 percent. Though limited by the unique aspects of the vA situation and by lack of a control group, the findings lend support to the efficacy and value of the GEU concept. (A randomized controlled study is in progress.) PMID:7299012
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
Sarginson, Jane E; Lazzeroni, Laura C; Ryan, Heather S; Schatzberg, Alan F; Murphy, Greer M
Genetic variation at the FKBP5 locus has been reported to affect clinical outcomes in patients treated with antidepressant medications in several studies. However, other reports have not confirmed this association. FKBP5 may regulate the sensitivity of the hypothalamic–pituitary–adrenal axis. We tested two FKBP5 single nucleotide polymorphisms (rs1360780 and rs3800373) in a sample of 246 geriatric patients treated for 8 weeks in a double-blind randomized comparison trial of paroxetine and mirtazapine. These two polymorphisms had previously been reported to predict efficacy in depressed patients treated with selective serotonin reuptake inhibitors such as paroxetine, and those treated with mirtazapine, an agent with both serotonergic and noradrenergic actions. However, we found no significant associations between these FKBP5 genetic variants and clinical outcomes. Neither mean Hamilton Depression Rating Scale scores nor time to remission or response were predicted by FKBP5 genetic variation. These results suggest that FKBP5 is unlikely to play a major role in determining antidepressant treatment outcomes in geriatric patients.
Sarginson, Jane E.; Lazzeroni, Laura C.; Ryan, Heather S.; Schatzberg, Alan F.; Murphy, Greer M.
This descriptive study compares geriatric defendants (n = 57) found competent to stand trial (n = 36) with those found incompetent (n = 21). A review of the records of 57 consecutive pretrial geriatric detainees who underwent competence-to-stand-trial evaluation was conducted. The review included comparison of demographic and historical variables, mental status examination (MSE) elements, and trial abilities. Incompetent subjects were older and more frequently had dementia, but did not necessarily have other psychiatric illnesses. Deficits in orientation, memory, abstraction, concentration, calculation, and thought process were associated with incompetence. Deficits in orientation and memory correlated most highly with incompetence. Trial-related deficits associated with incompetence included failure to understand Miranda warnings, legal charges, potential penalties, roles of court officers, pleas, and plea-bargaining and inability to consult with an attorney and be self-protective. The ability to maintain appropriate courtroom behavior was not different between groups. The inability to consult with an attorney and understand Miranda was most predictive of incompetence-to-stand-trial opinions. PMID:12108562
Frierson, Richard L; Shea, Steven J; Shea, Mary E Craig
The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer’s disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cut-off scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer’s disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in 3 of the 4 clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.
Duff, Kevin; Spering, Cynthia C.; O'Bryant, Sid E.; Beglinger, Leigh J.; Moser, David J.; Bayless, John D.; Culp, Kennith R.; Mold, James W.; Adams, Russell L.; Scott, James G.
Abstract Aging is inevitable, every day we live we age. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. Oral health reflects overall well being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in age. Diagnosis and proper treatment is essential for healthy aging. Timely diagnosis, appropriate treatment and regular follow-up of both oral and systemic diseases are a prerequisite for active aging. Oral diagnostics is a revolutionary development with high potential to replace other investigative modalities. Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. This paper is aimed to shed light on the growing elderly population and their ailments. It also aims to create awareness among health care providers about oral diagnostics and their application in geriatrics. PMID:23617577
Drug interactions are a common cause of iatrogenic disease in geriatric patients. Computer programs now exist which allow one to analyse groups of drugs for potential interactions. In an audit of charts of 100 geriatric patients seen in the Family Practice Center at Barberton Citizens Hospital, a computer printout was obtained, listing all patients aged 60 years and over who were seen at the Center during 1989. Names were selected randomly from this list by the head nurse and their charts were obtained for review, generating information on patient identification number, age, sex, diagnoses, medications, and allergies. The medications were analysed using the Hansten Drug Interaction Knowledge Base Program, which identified 27 patients as being on a combination of medications which had one or more potential drug interactions. A total of 37 potential drug interactions were identified in this group of 27 patients. Relative risk ratios were determined using the computer program, 'Epi Info,' for sex (female versus male), age (greater than or equal to 75 vs. 60-75 years), number of diagnoses greater than or equal to 3 vs. 0-2), and number of medications (greater than or equal to 4 vs. 0-3). The five medications, or groups of medications, which were most likely to be involved in potential drug interactions were digoxin, beta-blockers, oestrogen, oral hypoglycaemic agents, and diuretics. PMID:1822974
Background: Although the frequency of spinal surgical procedures has been increasing, particularly in patients of age 65 and over (geriatric), multiple overlapping comorbidities increase their risk/complication rates. Nevertheless, sometimes these high-risk geriatric patients are considered for “unnecessary”, too much (instrumented fusions), or too little [minimally invasive surgery (MIS)] spine surgery. Methods: In a review of the literature and reanalysis of data from prior studies, attention was focused on the increasing number of operations offered to geriatric patients, their increased comorbidities, and the offers for “unnecessary” spine fusions, including both major open and MIS procedures. Results: In the literature, the frequency of spine operations, particularly instrumented fusions, has markedly increased in patients of age 65 and older. Specifically, in a 2010 report, a 28-fold increase in anterior discectomy and fusion was observed for geriatric patients. Geriatric patients with more comorbid factors, including diabetes, hypertension, coronary artery disease (prior procedures), depression, and obesity, experience higher postoperative complication rates and costs. Sometimes “unnecessary”, too much (instrumented fusions), and too little (MIS spine) surgeries were offered to geriatric patients, which increased the morbidity. One study observed a 10% complication rate for decompression alone (average age 76.4), a 40% complication rate for decompression/limited fusion (average age 70.4), and a 56% complication rate for full curve fusions (average age 62.5). Conclusions: Increasingly, spine operations in geriatric patients with multiple comorbidities are sometimes “unnecessary”, offer too much surgery (instrumentation), or too little surgery (MIS).
A B S T R A C T Introduction: The Rural Clinical School of Western Australia (RCSWA) provides 25% of Western Australia's medical students in their first full clinical year with a longitudinal integrated clerkship in rural and remote areas. They live and work in 10 different sites in groups of 3 to 10 members. This study aimed to discover
Despite increasing numbers of geriatric prisoners, little is known about geriatric disability or health care in prison. Although correctional officers often act as a liaison between prisoners and the healthcare system, the role of officers in recognizing geriatric disability has not been characterized. The goals of this study were to assess officers' assessment of disability in their assigned geriatric prisoners and to contrast their views with reports from the California Department of Corrections and Rehabilitation (CDCR). Questionnaires were given to 71 officers assigned to 618 randomly selected geriatric prisoners in 11 prisons. Information about 41 additional prisoners identified by correctional officers as "high risk" was also analyzed. Prisoner disability and health were determined through correctional officer questionnaires (activity of daily living (ADL) impairment, geriatric syndromes, level of care), chart review (medical diagnoses), and CDCR data (demographics, disability designation). Overall, 211 (34.1%) geriatric prisoners were unknown to their officer. Of the 407 known prisoners, officers reported that 5.0% had ADL impairment and 3.1% were unsafe. Discordance between officer and CDCR reports of disability was common, with officers reporting higher disability rates. The 41 high-risk prisoners were more likely to have ADL impairment (22.0% vs 5.2%, P<.01) and geriatric syndromes such as falls and incontinence than the random sample. Overall, nearly one-third of geriatric prisoners were unknown to their assigned officer. Officers identified more disability than the CDCR, and prisoners they identified as high risk had nursing home-level functional impairments. Significant improvement in disability assessment is needed for officers and the CDCR. PMID:19582902
Williams, Brie A; Lindquist, Karla; Hill, Terry; Baillargeon, Jacques; Mellow, Jeff; Greifinger, Robert; Walter, Louise C
The purpose of this article is to describe the development of an innovative educational strategy for incorporating geriatric content into an undergraduate parent-child nursing course. Faculty supervised the development of an interactive media-based module that met content objectives for the parent-child course and included the functional assessment of the geriatric client living in a home setting. Students found this module to be a creative, user-friendly, and practical application of theory to a realistic clinical situation. This strategy successfully infused geriatric content into a pediatric course to enhance students' abilities to care for older adults. PMID:17378187
Medical students have been rating clinical teaching in an obstetrics and gynecology clerkship at the University of Washington using an assessment form designed to reflect six factors of clinical teaching effectiveness. High interrater reliability and the utility of the data for faculty development and advancement are discussed. (Author/JMD)
Distress and senescence, their reciprocal aggravating-quickening connections, and their related pathologies have a large worldwide impact on healthcare systems in this new millennium. For this reason, Antagonic-Stress (AS)--an advanced integrative therapy, with specific synergistic composition, and patented internationally--represents a significant strategy in health, aging, and longevity. Clinical research with AS proves the drug's efficacy in the management of distress (neurotic, stress-related, and affective disorders; behavioral syndromes associated with physiological disturbances and physical factors; mental and behavioral disorders due to psychoactive substance uses) and psychogeriatrics [organic, including symptomatic, mental disorders (OMD)]. Specific multiaxial psychopathological instruments and psychometric tests in multiple assessments used for gerontopsychiatry demonstrated strong improvements after AS administration in early-moderate stages of Alzheimer or vascular dementia, as well as in other OMD. In addition, comparative clinical studies evinced the superiority of AS (synergistic multitherapy) versus monotherapy [meclofenoxate (MF), piracetam (PA), pyritinol (PT), and nicergoline (NE), respectively]. These comparative clinical trials agreed closely with comparative preclinical research and confirmed AS synergistic homeostatic, adaptogenic, antioxidative, cerebrovascular, neurometabolic, and nootropic actions. Also, the AS protective actions against oxidative stress recommend this orthomolecular therapy in stress, aging, and free radical pathology. PMID:15247054
Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls.
Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.
|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…
Explores nature of physician decision making in the case of elderly who reside in the community. Interviews with 40 physicians revealed 3 dilemma sources: (1) how much to intervene in patients' lives to reduce risk; (2) structural, moral, and medical limits to patient advocacy; and (3) assessing vulnerability and quality of life when pondering…
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…
This geriatric profile specifically reflects the impressive achievements of Thomas Jefferson during the years of his retirement (ages 66-83) following a distinguished political career culminating in the Presidency. President Monroe sought his advice even after the age of 80, and Jefferson's reasoning was instrumental in the formulation of the Monroe Doctrine. Education was a foremost priority in retirement. He was responsible for the establishment of the University of Virginia, in which his versatility was manifested as architect, builder, and fund raiser. Jefferson was a man of breadth and extraordinary vision for his time, and has come to be known as the "Father of American Democracy." The basic concepts of his philosophy, including the realm of aging, remain valid today-150 years after his passing. PMID:320248
Aging of the "baby-boom" generation and increased life expectancy will mean a projected population increase of persons 65 and older from 39 to 65 million between 2010 and 2030. Surveys conducted among members of the American Association of Retired Persons (AARP) reflect their wish to establish a more equal part in the physician-patient relationship and to participate in local and federal health care monitoring and reform. Accordingly, many are asking for health information and are prepared to change heretofore ineffectual communication with the health care system--whether in their personal physician's office or at the federal level. Only a fraction of practicing physicians report geriatrics as a primary or secondary specialty. Family practitioners and internists are likely to continue to provide the major share of medical care to the elderly in the future. PMID:10294289
Rectal motility was assessed in three groups of geriatric patients (faecally incontinent, continent faecally impacted and control patients) to determine whether 'uninhibited' rectal contractions are a cause of faecal incontinence. The incidence of rectal contractions in response to rectal distension did not differ between the three study groups. Two-thirds of the incontinent patients were unable to retain a condom distended with water (soft-stool model) during a proctometrogram. Involuntary expulsion of this device was correlated with the presence of rectal contractions and low anal resting pressure. Involuntary expulsion of an airfilled balloon (firm-stool model) from the rectum occurred less frequently and was correlated with low resting pressure but not with rectal contractions. The contribution of 'uninhibited' rectal contractions to faecal incontinence is insignificant except for a minor role in the expulsion of liquid stool. PMID:2251964
Barrett, J A; Brocklehurst, J C; Kiff, E S; Ferguson, G; Faragher, E B
The aim of this study was to perform a psychometric analysis on the Geriatric Oral Health Assessment Index (GOHAI) using Rasch analysis, a modern statistical approach for examining rating scale data. Eighty-five subjects, long-term residents of a nursing home, were analysed using the GOHAI. The mean GOHAI score (range 0-48) was 11. Two of the five rating categories (1 = seldom; 3 = often) did not comply with the Rasch criteria for category functioning. After collapsing rating categories into a three-level rating scale (0 = never; 1 = sometimes; 2 = often/always), the new model met the set criteria. Item 12 'sensitivity to hot, cold or sweets' was misfitting. Rasch analysis showed both the unidimensionality of (at least) 11 of the 12 items of GOHAI, and the possibility of simplifying the structure of its rating scale. PMID:20572862
Serious problems have been identified in the prescribing of medications for elderly patients and use of prescription and nonprescription drugs by older persons. Overuse, underuse, and inappropriate use of drugs by the elderly have been widely documented, and the harmful consequences have been described. This paper reviews information concerning the need for action to improve health professionals' knowledge and skills with respect to drugs and the elderly and activities being undertaken by geriatric education centers (GECs) to enhance these capacities. Grant support for the centers from the Health Resources and Services Administration, a Public Health Service component agency, began in 1983. In fiscal year 1992 there are 31 centers operating in 26 States. The centers are multi-institutional and conduct four types of educational activities. These include review of pharmacological issues for multidisciplinary groups, specialized training for pharmacists, discipline-specific programs focusing on medication issues, and activities aimed at educating the public. Examples of the GECs' educational activities are given.
The percentage of elderly people in the United States is increasing. They are remaining active and independent and are experiencing injury at the same rate as the rest of the population. Although the elderly are subject to the same mechanisms of injury as other age groups, geriatric patients are unique in their responses to injury. The physiologic, metabolic, and biomechanical changes that occur with aging can affect the ability to withstand major stress, can increase the incidence of complications, and can decrease the chance for survival. Trauma care providers should be aware of the many changes that occur with aging and how to modify care to assist this group of patients to maximum recovery. PMID:9079335
Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person's privacy. Attending a day centre confers much benefit, but one must understand the old person's resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person's competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated.
ObjectiveThis study aimed to describe the nutritional status of geriatric home residents according to their place of dwelling and to identify institutional factors associated with higher rates of undernutrition.
Isabelle Bourdel-Marchasson; Charlotte Rolland; Marthe-Aline Jutand; Christian Egea; Béatrice Baratchart; Pascale Barberger-Gateau
Geriatric dermatoses are a challenging job for the physician in terms of diagnosis, management, and followup. Since skin of the elderly population is going through a lot of changes from both an intrinsic and extrinsic point of view, it is imperative for the physician to have a better understanding of the pathophysiology of geriatric skin disorders and their specific management, which differs slightly from an adult population. This review focuses on a brief introduction to the pathophysiological aspects of skin disorders in elderly, the description of some common geriatric skin disorders and their management and the new emerging role of psychodermatological aspects of geriatric dermatoses is also discussed. At the end, ten multiple choice questions are also added to further enhance the knowledge base of the readers. PMID:22515576
Jafferany, Mohammad; Huynh, Trung V; Silverman, Melissa A; Zaidi, Zohra
|Contains 18 articles discussing the uses of behavioral medicine in such areas as obesity, smoking, hypertension, and headache. Reviews include discussions of behavioral medicine and insomnia, chronic pain, asthma, peripheral vascular disease, and coronary-prone behavior. Newly emerging topics include gastrointestinal disorders, arthritis,…
|In "Narrative Medicine: Honoring the Stories of Illness," Rita Charon paints an original and humane portrait of what it can mean to be a doctor, to live a life immersed in sickness and dedicated to wellness. Charon drops the veil, inviting readers to look at the secret, subjective, emotional face of medicine, a zone of self-censored feelings and…
Competency-based education prepares trainees to perform tasks occurring within the context of practice. There are currently no geriatrics-specific, competency-based consensus performance standards for medical students. The authors present the results of a systematic, multimethod process to identify and define the minimum geriatrics-specific competencies needed by a new intern to adequately care for older adults. An alpha draft was crafted by
Rosanne M. Leipzig; Lisa Granville; Deborah Simpson; M Brownell Anderson; Karen Sauvigné; Rainier P. Soriano
Aim: Evaluation of renal function and relation to risk factors for renal failure in very old patients admitted to an acute geriatric\\u000a ward. Methods: Retrospective chart review ofpatients aged 80 years and over, admitted to the acute geriatric ward from August 1998 till\\u000a August 1999. Recorded data were: age,gender, previous medical history, primary diagnosis, medicationuse, weight, serum creatinine,\\u000a BUN, sodium,
Nele J. Van Den Noortgate; Wim H. Janssens; Marcel B. Afschrift; Norbert H. Lameire
Background. Elderly hospitalized patients have low survival rates after cardiopulmonary resuscitation, especially in the long term. This study aims to investigate the prevalence of patients with do-not-resuscitate (DNR) status on acute geriatric wards and the characteristics of the preceding decision-making process. Methods. On all 94 geriatric wards in Flanders, Belgium (2002), the geriatrician who performed the bulk of clinical work
Cindy De Gendt; Johan Bilsen; Nele Van Den Noortgate; Margareta Lambert; Robert Vander Stichele; Luc Deliens
This study evaluated the validity and reliability of the Hebrew version of the Geriatric Depression Scale Short Form (GDS-SF) in an Israeli geriatric population. Twenty-seven inpatients with a diagnosis of major depression according to the DSM-IV criteria and 21 healthy volunteers were assessed with the GDS-SF Hebrew Version, Hamilton Depression Rating Scale (HAM-D), and Mini-Mental State Examination (MMSE). The GDS-SF
G. Zalsman; D. Aizenberg; M. Sigler; E. Nahshoni; A. Weizman
We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.
Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L
The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care.
... about medicines to treat Alzheimer’s disease, see the “Alzheimer’s Disease Medications Fact Sheet,” www.nia.nih.gov/alzheimers/publication/alzheimers- disease-medications-fact-sheet. The Alzheimer’s Disease Education and Referral ( ...
It is only since the late 20th century that Sport and Exercise Medicine has emerged as a distinct entity in health care. In Israel, sports medicine is regulated by a State Law and a sport physician is certified after graduating a structured program. In the past, sports medicine was related to the diagnosis and treatment of injuries encountered by top athletes. In recent years, the scope of sport medicine has broadened to reflect the awareness of modern society of the dangers of physical inactivity. In this perspective the American College of Sport Medicine (ACSM) recently launched a program--"Exercise is Medicine", to promote physical activity in order to improve health and well-being and prevention of diseases through physical activity prescriptions. This program is from doctors and healthcare providers, adjusted to the patient or trainee. The sport physician does not replace a medical specialist, but having a thorough understanding about the etiology of a sport-related injury enables him to better focus on treatment and prevention. Therefore, Team Physicians in Elite Sport often play a role regarding not only the medical care of athletes, but also in the physiological monitoring of the athlete and correcting aberrations, to achieve peak physical performance. The broad spectrum of issues in sport and exercise medicine cannot be completely covered in one issue of the Journal. Therefore, the few reports that are presented to enhance interest and understanding in the broad spectrum of issues in sports and exercise medicine are only the tip of the iceberg. PMID:22741210
\\u000a In the era of multimodality imaging techniques, functional information represents a remarkable aspect in medical imaging and\\u000a nuclear medicine is the technique par excellence for functional information. One of the first applications of radioactive\\u000a substances in clinical practice is represented by renal disorders, nowadays largely investigated by nuclear medicine examinations.\\u000a Among the different physiologic processes in which kidneys take part,
... Home » Health and Aging » Publications Safe Use of Medicines Introduction Neighbors Gail and Alice talk about medicine ... Learn more about medicine safety Safe Use of Medicines Take Your Medicine the Right Way—Each Day! ...
Background The Angoff method is one of the preferred methods for setting a passing level in an exam. Normally, group meetings are required, which may be a problem for busy medical educators. Here, we compared a modified Angoff individual method to the conventional group method. Methods Six clinical instructors were divided into two groups matched by teaching experience: modified Angoff individual method (three persons) and conventional group method (three persons). The passing scores were set by using the Angoff theory. The groups set the scores individually and then met to determine the passing score. In the modified Angoff individual method, passing scores were judged by each instructor and the final passing score was adjusted by the concordance method and reliability index. Results There were 94 fourth-year medical students who took the test. The mean (standard deviation) test score was 65.35 (8.38), with a median of 64 (range 46–82). The three individual instructors took 45, 60, and 60 minutes to finish the task, while the group spent 90 minutes in discussion. The final passing score in the modified Angoff individual method was 52.18 (56.75 minus 4.57) or 52 versus 51 from the standard group method. There was not much difference in numbers of failed students by either method (four versus three). Conclusion The modified Angoff individual method may be a feasible way to set a standard passing score with less time consumed and more independent rather than group work by instructors.
Poor appetite is one of the main contributing factors of poor nutritional status among elderly individuals. Recognizing the importance of assessment of appetite, a cross sectional study was conducted to determine the validity of appetite screening tools namely, the Council on Nutrition Appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) against the appetite, hunger and sensory perception questionnaire (AHSPQ), measures of nutritional status and food intake among geriatric patients at the main general hospital in Malaysia. Nutritional status was assessed using the subjective global assessment (SGA) while food intake was measured using the dietary history questionnaire (DHQ). Anthropometric parameters included weight, height, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A total of 145 subjects aged 60 to 86 years (68.3 ± 5.8 years) with 31.7% men and 68.3% women were recruited from outpatients (35 subjects) and inpatients (110 subjects) of Kuala Lumpur Hospital of Malaysia. As assessed by SGA, most subjects were classified as mild to moderately malnourished (50.4%), followed by normal (38.6%) and severely malnourished (11.0%). A total of 79.3% and 57.2% subjects were classified as having poor appetite according to CNAQ and SNAQ, respectively. CNAQ (80.9%) had a higher sensitivity than SNAQ (69.7%) when validated against nutritional status as assessed using SGA. However, the specificity of SNAQ (62.5%) was higher than CNAQ (23.2%). Positive predictive value for CNAQ and SNAQ were 62.6% and 74.7%, respectively. Cronbach's alpha for CNAQ and SNAQ were 0.546 and 0.578, respectively. History of weight loss over the past one year (Adjusted odds ratio 2.49) (p < 0.01) and thiamine intake less than the recommended nutrient intake (RNI) (Adjusted odds ratio 3.04) (p < 0.05) were risk factors for poor appetite among subjects. In conclusion, malnutrition and poor appetite were prevalent among the geriatric outpatients and inpatients. SNAQ was more reliable and valid as an appetite screening tool among this special group of population. There is a need to regularly include nutritional and appetite assessment for early intervention measures in order to prevent consequences of malnutrition. PMID:22836710
Papers in these proceedings are organized into four sections: (1) Research Studies in Aging; (2) Innovative Approaches in Geriatric Education; (3) Faculty Development Models; and (4) "The Publication Process: Perils and Pearls" (Workshop). Clinical Experiences: Design Not Chance" (Matzo); "The Development of a Collaborative Gerontological Research…
Given the anticipated limited availability of geriatricians for the foreseeable future, how should the geriatrician's spe- cialized clinical skills be deployed to optimally benefit the health of our aging population? Directors of geriatrics ac- ademic programs (DGAPs) at all 145 U.S. allopathic and osteopathic medical schools were asked this question as part of a winter 2007 on-line survey. The DGAPs
Gregg A. Warshaw; Elizabeth J. Bragg; Linda P. Fried; William J. Hall
|Papers in these proceedings are organized into four sections: (1) Research Studies in Aging; (2) Innovative Approaches in Geriatric Education; (3) Faculty Development Models; and (4) "The Publication Process: Perils and Pearls" (Workshop). Clinical Experiences: Design Not Chance" (Matzo); "The Development of a Collaborative Gerontological…
The Geriatric Depression Scale (GDS)-15 was used in 607 adults aged 65+ years living in a community, nursing homes, and a general hospital to explore characteristics of depressive mood in different care settings. Factor analysis of GDS-15 extracted 4 factors labeled unhappiness, apathy and anxiety, loss of hope and morale, and energy loss. The scale scores labeled unhappiness, apathy and
Although the Mesopotamian civilisation is as old as that of Egypt and might even have predated it, we know much less about Mesopotamian medicine, mainly because the cuneiform source material is less well researched. Medical healers existed from the middle of the 3rd millennium. In line with the strong theocratic state culture, healers were closely integrated with the powerful priestly fraternity, and were essentially of three main kinds: barû (seers) who were experts in divination, âshipu (exorcists), and asû (healing priests) who tended directly to the sick. All illness was accepted as sent by gods, demons and other evil spirits, either as retribution for sins or as malevolent visitations. Treatment revolved around identification of the offending supernatural power, appeasement of the angry gods, for example by offering amulets or incantations, exorcism of evil spirits, as well as a measure of empirical therapy aimed against certain recognised symptom complexes. Medical practice was rigidly codified, starting with Hammurabi's Code in the 18th century BC and persisting to the late 1st millennium BC. Works like the so-called Diagnostic Handbook, the Assyrian Herbal and Prescription Texts describe the rationale of Mesopotamian medicine, based predominantly on supernatural concepts, although rudimentary traces of empirical medicine are discernible. There is evidence that Egyptian medicine might have been influenced by Mesopotamian practices, but Greek rational medicine as it evolved in the 5th/4th centuries BC almost certainly had no significant Mesopotamian roots. PMID:17378276
Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community. PMID:15039693
A meeting jointly organised by the Academy of Pharmaceutical Sciences (APSGB), the GeriatricMedicine Society and the UCL School of Pharmacy took place on the 13th of March 2013, in Stevenage, UK. The meeting was attended by a number of experts involved with the treatment and development of drugs for the older adult, including clinicians, pharmacists, academics, regulators and representatives from industry. The event created the platform to discuss the provision of medicines for older adults from a pharmaceutical sciences perspective. PMID:23916726
Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide being more prevalent in old age. The present survey of hypertensive patients fulfilling the standard diagnostic criteria of WHO/ISH (2004) is carried out in geriatric age group from the Saurashtra region of Gujarat in India to observe the dietary pattern and provocative factors. Total 120 patients of 50 to 80 years of age having systolic blood pressure >140 mm Hg and ?180 mm Hg and diastolic blood pressure >90 mm Hg and ?110 mm Hg irrespective of gender and religion were selected for the present study. They were interviewed for list of provocative factors enlisted in Ayurveda. As observed, the study supported the facts described in Ayurveda that dietary etiological factors, such as excess intake of Lavana (salty), Amla (sour), Katu (pungent), Tikshna, Ushna (hot), Vidahi (producing burning sensation), Viruddha (incompatible), Snigdha (unctuous), Abhishyandi (leading to obstruction), Madhura (sweet), Guru (heavy to digest) dietary articles, Ajirnashana (taking diet before complete digestion of previous meal), Adhyashana (repeated eating at short intervals), will vitiate Rakta dhatu as well as Pitta dosha in the body leading to disorders like hypertension. Hypertension in old age is found to be a disease of Vata-Pitta dominant vitiation with the involvement of Rasa, Rakta, Meda as main Dushya (vitiated factors) and dietary factors can contribute to worsening of the disease. The etiological factors having role in the pathogenesis can also be applied for preventive guidelines for the management of hypertension.
Jagtap, Madhavi V.; Deole, Yogesh S.; Chandola, Harimohan; Ravishankar, B.
The objectives of this study were to design and prospectively evaluate a strategy to assess geriatric urinary incontinence in primary care settings. A management plan for urinary incontinence was determined for 264 elderly incontinent patients (205 females and 59 males) based on a clinical evaluation, simple tests of lower urinary tract function, and several criteria for referral for further evaluation derived from the literature on incontinence. Of the 264 patients, 168 (64%) also consented to undergo a urologic and formal urodynamic evaluation. Half of these 168 patients met at least one criterion for referral for further evaluation. At least one-quarter of the patients who met one or more of the criteria were found not to require surgical intervention, and probably did not benefit from the urologic and urodynamic evaluation. Among 84 patients who did not meet any of the criteria for referral, the urologic and urodynamic evaluation changed the initial treatment plan in only 10 (12%). The risks associated with the treatment plan based on the clinical assessment in these patients were, however, relatively small. While further refinement and testing in larger numbers of incontinent patients are needed, the data presented document that a substantial proportion of elderly patients with a treatable and often ignored problem can be appropriately managed based on a relatively simple and inexpensive assessment, which can easily be carried out in primary care settings. PMID:2754156
Abstract Older patients and their families desire control over health decisions in serious illness. Experts recommend discussion of prognosis and goals of care prior to decisions about treatment. Having achieved longevity, older persons often prioritize other goals such as function, comfort, or family support-and skilled communication is critical to shift treatment to match these goals. Shared decision making is the ideal approach in serious illness. Older patients desire greater family involvement; higher rates of cognitive impairment mean greater dependency on surrogates to make decisions. Despite the importance of communication, fewer than half of older patients or families recall treatment discussions with clinicians, and poor quality communication adversely affects family satisfaction and patient outcomes. Direct audiorecording of clinical encounters and longitudinal studies of communication and treatment decisions have yielded important insights into the quality of clinical communication. Current clinical practice rarely meets standards for shared decision making. Innovative methods to record and use patient preferences show promise to overcome the limitations of traditional advance directives. Decision aids, intensive clinician training, and structured interpersonal communication interventions have all been shown to be effective to improve the quality of communication and decision making. Priorities for geriatric palliative care research, building on these insights, now include empirical testing of communication approaches for surrogates and for diverse populations, exploration of meaningful ways to communicate prognosis, and expansion of intervention research. PMID:24007351
Summary: Background and Aims: Research dealing with occupational strain and burnout in geriatric care is generally focused on the behavioral problems of the patient and/or the psychological traits or attitudes of the carers rather than on organizational functionality. This paper describes data from a survey of all geriatric professions, using the Stressful Events Questionnaire (SEQ), a tool that takes into account multiple dimensions that can affect the genesis of burnout, including the patient, the geriatric health care professional, and the health care organization. The aim of this study is to compare patterns of answers among different roles in geriatric care. Method: Patterns of SEQ answers are described for the entire sample as well as for workers experiencing burnout and for each caring profession investigated: certified nursing assistants (CNAs), registered nurses and physicians/psychologists. Results; In general, carers refer more often as stressful the facility-related events; the only exception is that CNAs working in general hospital geriatric wards refer most often as stressful the patient-related events. The self-related events area seems to have a great importance for all professions. Discussion: The specificity of gerontological burnout has to be discussed, to better define the role played by caring problems, including psychological attitudes of carers versus the role played by the institution and by the social situation of each worker. For CNAs, the interaction between educational background and the length of time spent as a CNA seems to be a critical topic.
Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer. PMID:22377757
Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B
In a critical situation of world official medicine, we can find different alternatives therapies: natural therapy traditional and complementary, survival sometimes, of antique stiles and conditions of life. New sciences presented for them empiricism to the margin of official science. Doctors and sorcerer do the best to defeat the horrible virus that contribute to build symbols categories of sick. The alternatives put dangerously in game the scientific myth of experiment and exhume, if they got lost, antique remedy, almost preserved like cultural wreck very efficient where the medicine is impotent. Besides alternatives and complementary therapies, that are remedies not recognized conventional from official medicine, there are the homeopathic, phytotherapy, pranotherapy, nutritional therapy, the ayurveda, the yoga, ecc. Italians and internationals research show a composite picture of persons that apply that therapies. Object of this work is to understand and know the way that sick lighten their sufferings and role that have o that can assume the nurses to assist this sick. PMID:12146072
Medical school entrance depends on passing a central examination that is given annually by the National Selection and Placement Center. Undergraduate medical education takes 6 years. About 5000 students graduate from medical faculties annually. The central exam necessary for residency training is given by the National Selection and Placement Center. A Specialist Training Regulation regulates residency training. Internal medicine residency training takes 4 years and includes inpatient and outpatient care in wards and rotations. Residents prepare a dissertation that is used in the evaluation of residency competency. At the end of the residency period, residents who have been successful in previous evaluations take an oral exam followed by a written exam, which lead to their certification in internal medicine. Residents' scientific knowledge and skills are assessed by a jury consisting of five people, four from the same department and one from the equivalent department in another training institution. The title of specialist is granted after a certification exam given by training institutions and approved by the Ministry of Health. Internists are mainly employed in state hospitals, which are under the Ministry of Health. Subspecialty areas in internal medicine include gastroenterology, geriatrics, endocrinology, nephrology, hematology, rheumatology, immunology, allergology, and oncology. The training period for a subspecialty is 2 years. A substantial effort is being made all over the country to improve regulations and health care service delivery. These changes will also affect the residency training and manpower planning and employment of internists. PMID:16314242
Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease
Health care workers at eight sites were trained to serve on interdisciplinary geriatric care teams. Challenges included differing levels of experience and geriatric knowledge, discipline specific-language and practice philosophies, and scheduling conflicts. Techniques to overcome them included case studies, standardized patients, cross-discipline…
Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in
Patrizia Mecocci; Eva von Strauss; Antonio Cherubini; Sara Ercolani; Elena Mariani; Umberto Senin; Bengt Winblad; Laura Fratiglioni
Twenty-six matched pairs of elderly male patients who had been evaluated in an outpatient geriatric evaluation unit (GEU) were assigned randomly to be followed in either a geriatrics clinic with an interdisciplinary team or a general medical clinic without an interdisciplinary team. Patients were medically stable and living in the community. At 12 months no difference was found in cognitive, affective, or functional status. Both groups of patients had similar frequencies of hospitalization, community placement, use of community services, and number of deaths. These findings suggest that the major benefit from GEUs may be in the initial assessment and treatment rather than in the subsequent care provided by interdisciplinary teams in geriatrics specialty clinics. PMID:3819345
Kerski, D; Drinka, T; Carnes, M; Golob, K; Craig, W A
This descriptive study explored the influence of specific geriatric knowledge on second and third year nursing students in their provision of care to older adults. Nineteen student participants provided qualitative data on their values and beliefs about nursing older adults prior to their attendance at a 1-h session teaching about two assessment tools: SPICES (Sleep disorders, Problems with feeding, Incontinence, Confusion, Evidence of falls, Skin breakdown) and BPI-SF (Brief Pain Inventory-Short Form). Data were again collected following a 6-week practice experience in which the same students had the opportunity to implement the tools. Four emerging themes, beliefs, knowledge, attitudes, and application, suggested how the students' geriatric knowledge and attitudes evolved and took on personal meaning in their intermediate practice experiences. Their realization of the hegemony associated with devaluing of the care of older adults warrants further examination into how geriatric knowledge is conveyed and assimilated. PMID:23465846
In 1985 and 1986 nuclear medicine became more and more oriented toward in vov chemistry, chiefly as a result of advances in positron emission tomography (PET). The most important trend was the extension of PET technology into the care of patients with brain tumors, epilepsy, and heart disease. A second trend was the increasing use of single-photon emission computed tomography
|Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)|
This article reviews the legislative history of Title VII of the United States Public Health Service Act. It describes three periods of federal support for health professions training in medicine and dentistry. During the first era, 1963 to 1975, federal support led to an increase in the overall production of physicians and dentists, primarily through grants for construction, renovation, and expansion of schools. The second period, 1976 to 1991, witnessed a shift in federal support to train physicians, dentists, and physician assistants in the fields of primary care defined as family medicine, general internal medicine, and general pediatrics. During this era, divisions of general internal medicine and general pediatrics, and departments of family medicine, were established in nearly every medical and osteopathic medical school. All three disciplines conducted primary care residencies, medical student clerkships, and faculty development programs. The third period, 1992 to present, emphasized the policy goals of caring for vulnerable populations, greater diversity in the health professions, and curricula innovations to prepare trainees for the future practice of medicine and dentistry. Again, Title VII grantees met these policy goals by designing curricula and creating clinical experiences to teach care of the homeless, persons with HIV, the elderly, and other vulnerable populations. Many grantees recruited underrepresented minorities into their programs as trainees and as faculty, and all of them designed and implemented new curricula to address emerging health priorities.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs. PMID:18971650
BACKGROUND: The demand for geriatric rehabilitation will drastically increase over the next years. It will be increasingly important to demonstrate the efficacy and effectiveness of geriatric rehabilitation. One component is the use of objective and valid assessment procedures. These should be understandable to patients, relevant for goal attainment, and able to document change. A number of currently used physical capacity measures have floor effects. The use of body-fixed sensor technology for monitoring physical activity is a possible supplement for the assessment during geriatric rehabilitation to overcome floor effects and directly monitor improvement of mobility as a component of geriatric rehabilitation in many patients. METHODS: The observational study with a pre-post design examined 65 consecutive geriatric hip fracture inpatients. Measurements were performed on admission and 2 weeks later. The capacity measures included gait speed, chair rise time, a balance test, 2-Minute-Walk test and the Timed-Up-and-Go test. Physical activity was measured over 9 h using body-fixed sensor technology and expressed as cumulated walking and walking plus standing (time on feet). RESULTS: Body-fixed sensors allowed direct measurement of physical activity in all patients available for testing. Cumulated walking and standing (time on feet) increased from a median 83.6 to 102.6 min. Cumulated walking increased from a median 7.0 to 16.3 min. The comparison with the physical capacity measures demonstrated a modest to fair correlation (rs?=?0.455 and 0.653). This indicates that physical capacity measures are not the same construct as physical activity. CONCLUSION: Body-fixed sensor-based assessment of physical activity was feasible even in geriatric patients with severe mobility problems and decreased the number of patients with missing data both on admission and 2 weeks later. Body-fixed sensor data documented change in activity level. PMID:23780628
Benzinger, P; Lindemann, U; Becker, C; Aminian, K; Jamour, M; Flick, S E
Background The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75?years or older. Methods/Design Patients aged 75?years or older admitted for a short hospital stay (?14?days) will be randomly assigned to either a usual care (control) group or an intervention (training) group. Participants allocated in the usual care group will receive normal hospital care and participants allocated in the intervention group will perform multiple sessions per day of lower limb strength training (standing from a seated position) and walking (10?min bouts) while hospitalized. The primary outcome to be assessed pre and post of the hospital stay will be functional capacity, using the Short Physical Performance Battery (SPPB), and time to walk 10 meters. Besides length of hospitalization, the secondary outcomes that will also be assessed at hospital admission and discharge will be pulmonary ventilation (forced expiratory volume in one second, FEV1) and peripheral oxygen saturation. The secondary outcomes that will be assessed by telephone interview three months after discharge will be mortality, number of falls since discharge, and ability to cope with activities of daily living (ADLs, using the Katz ADL score and Barthel ADL index). Discussion Results will help to better understand the potential of regular physical activity during a short hospital stay for improving functional capacity in old patients. The increase in life expectancy has resulted in a large segment of the population being over 75?years of age and an increase in hospitalization of this same age group. This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population. Trial registration ClinicalTrials.gov ID: NCT01374893.
Hospital admissions following emergency visits of elderly people are frequent. This admission modality is often problematic both for the patients and the emergency healthcare professionals. Direct admission from home (or nursing home) in acute geriatric units (AGU) has been developed but has never been prospectively assessed. We conducted a 6-month prospective observational study to compare the 97 patients admitted through the emergency room (ER) in the AGU of Bichat's hospital to the 76 patients admitted directly. Collected data included socio-demographic and medical baseline data, clinical severity score at admission, cause of hospitalization, final diagnosis, in-hospital occurrence of urinary retention and of pressure ulcer, length of stay, discharge disposition and mortality. No significant differences between the groups were found for most baseline characteristics, clinical severity score, occurrence of pressure ulcers, length of stay and mortality. However ER patients were significantly older (88±6 vs 86±7 years, p = 0.04) and had more often history of arrhythmia (29% vs 15%, p=0.02) and protein-energy malnutrition preceding admission (63% vs 46%, p=0.03). Falls as admission cause was more common in ER patients while unexplained health status or functional decline were most common in those admitted directly. Clinical outcomes were less favourable in ER patients with significantly more urinary retentions (25% vs 4%, p=0.0002) and transfers to rehabilitation units (48% vs 31%, p=0.04). The patients admitted directly returned more often at home without additional social support (53% vs 30%, p=0.001). Direct admission in AGU is feasible, medically effective and provides an alternative to attending an emergency room. This admission modality could be specially suitable for elder people suffering from an unexplained functional or health status declines. Further studies are necessary to support the hypothesis that quality gains and cost-effective measures may be achieved by dissemination of such an admission modality at the hospital. PMID:22713842
Background Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community. Methods We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires. Results On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7% (27.5% to 59.8%) of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18% whereas hearing impairment and depression was new to the physician in 74.1% and 76.5%, respectively. A substantial number of interventions were initiated not only following positive tests (43.7% per item; 95% CI 27.5% to 59.8%), but also as a consequence of negative test results (11.3% per item; 95% CI 1.7% to 20.9%). The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89%) and all physicians confirmed the CGA to provide new information in general on the patient's health status. All physicians judged the CGA to be feasible in everyday practice. Conclusion This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.
Mann, Eva; Koller, Michael; Mann, Christian; van der Cammen, Tischa; Steurer, Johann
... medicine is made to look and taste like candy. Children are curious and attracted to medicine. Most ... like you. Do not call medicine or vitamins candy. Children like candy and will get into medicine ...