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Sample records for geriatric medicine clerkship

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

    Background While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met “by random opportunity”.(1) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity. Methods Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings’ case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings’ teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital. Results The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met. Conclusions More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity. PMID:25452825

  3. Positioning Medical Students for the Geriatric Imperative: Using Geriatrics to Effectively Teach Medicine

    ERIC Educational Resources Information Center

    Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.

    2013-01-01

    Medical schools must consider innovative ways to ensure that graduates are prepared to care for the aging population. One way is to offer a geriatrics clerkship as an option for the fulfillment of a medical school's internal medicine rotation requirement. The authors' purpose was to evaluate the geriatrics clerkship's impact on…

  4. Description and students' perceptions of a required geriatric clerkship in postacute rehabilitative care.

    PubMed

    Bautista, Miho K; Meuleman, John R; Shorr, Ron I; Beyth, Rebecca J

    2009-09-01

    This article describes medical students' evaluation of a geriatric clerkship 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 geriatric clerkship 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

  5. Teaching Prevention in Internal Medicine Clerkships.

    ERIC Educational Resources Information Center

    Kinsinger, Linda

    2000-01-01

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

  6. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    ERIC Educational Resources Information Center

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

  7. Expectations of an emergency medicine clerkship director.

    PubMed

    Rogers, Robert L; Wald, David A; Lin, Michelle; Zun, Leslie S; Christopher, Theodore; Manthey, David E

    2011-05-01

    The clerkship director (CD) serves as a faculty leader within a school of medicine and plays a vital role in the hierarchy of undergraduate medical education. Collectively, CDs across specialties serve a multitude of roles and are responsible for clerkship administration, curricular development, teaching, mentoring, and advising students. The emergency medicine (EM) CD has a vitally important role to play in the future development of medical students. EM CDs should be valued and supported, because they often represent our specialty within the medical school and play a vital role in training the physicians of tomorrow. Opportunities and resources must be made available to CDs to run and maintain a successful EM clerkship, while also balancing their clinical duties and academic endeavors. In addition, EM CDs need support from their respective medical schools and departments to run highly successful medical student rotations. This article was prepared with the objective of establishing the importance of the EM CD, defining the job description of the CD, explaining the importance of adequate release time to perform the role of the CD, and describing the necessary resources and support for the position. With EM becoming an increasingly popular and integral rotation for medical students, it is likely that additional emphasis will be placed on the role of the EM CD. This reference document serves as a template for the job description and expectations of an EM CD. PMID:21521403

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

    ERIC Educational Resources Information Center

    Struck, Bryan D.; Teasdale, Thomas A.

    2008-01-01

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

  9. Current Trends in Geriatric Emergency Medicine.

    PubMed

    Kahn, Joseph H; Magauran, Brendan G; Olshaker, Jonathan S; Shankar, Kalpana N

    2016-08-01

    The number of geriatric visits to United States emergency departments continues to rise. This article reviews demographics, statistics, and future projections in geriatric emergency medicine. Included are discussions of US health care spending, geriatric emergency departments, prehospital care, frailty of geriatric patients, delirium, geriatric trauma, geriatric screening and prediction tools, medication safety, long-term care, and palliative care. PMID:27475008

  10. Development and Modification of a Required Family Medicine Clerkship.

    ERIC Educational Resources Information Center

    Michener, J. Lloyd; And Others

    1985-01-01

    A new required clinical clerkship in family medicine at Duke University School of Medicine is described in terms of planning, implementation, and modification in response to students' evaluations. The data demonstrate that family medicine can be taught effectively as a core clinical rotation. (Author/MLW)

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

    ERIC Educational Resources Information Center

    Parkerson, George R., Jr.; And Others

    1984-01-01

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

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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

  13. ETHICS IN GERIATRIC MEDICINE RESEARCH

    PubMed Central

    İlgili, Önder; Arda, Berna; Munir, Kerim

    2014-01-01

    This article aims to evaluate the research process in geriatrics from the ethical point of view. The elderly population is increasing rapidly, but there is no parallel in the amount of research concerning this demographic. On the other hand, in the light of research ethics, this group mainly represents vulnerable people and requires more sensitivity. Taking into account all these features, fundamental principles in research ethics are first considered: the soundness of the scientific project, qualifications of the investigators, ethics committee approval, informed consent, confidentiality and privacy, beneficence/nonmaleficence, and justice are evaluated. Special ethical issues in geriatric research such as ageism and research inclusion, paucity of research involving elderly people, vulnerability of elderly subjects, and cognitive impairments are discussed separately. PMID:25489272

  14. Innovative educational practices in a required family medicine clerkship.

    PubMed

    Quinby, P M

    1993-01-01

    This paper traces the 7-year evolution of a required clerkship in Family Practice from the time of initial grant application to the current academic year. Results of experience in areas of student placement, preceptor recruitment, curriculum development, test construction, grading schema and course evaluation are described. Emphasis on streamlining administrative systems to decrease paperwork of course director is a major focus. Changing needs of department, medical school and student are reflected in the adaptations of the clerkship to these needs. PMID:8326845

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  16. Drug Abuse Training as Part of a Family Medicine Clerkship.

    ERIC Educational Resources Information Center

    Confusione, Michael; And Others

    1982-01-01

    A program incorporating experiential and didactic experience in identification and treatment of drug abuse into third-year clerkship curriculum is described. Experiential training is in a methadone maintenance clinic. Students are evaluated on their knowledge, attitudes, and level of participation in the drug abuse treatment. (MSE)

  17. A Reflection on Aging: A Portfolio of Change in Attitudes toward Geriatric Patients during a Clerkship Rotation

    ERIC Educational Resources Information Center

    Del Duca, Danny; Duque, Gustavo

    2006-01-01

    The process of students' evaluation in medical schools has changed from a tutor-led evaluation system based on students' performance to a student-based evaluation that involves self-reflection and their level of change in skills and attitudes. At the McGill University Division of Geriatric Medicine, we developed an innovative system of evaluation…

  18. A Third-Year Family Medicine Clerkship Based in an Academic Family Practice Center.

    ERIC Educational Resources Information Center

    Taylor, Robert B; And Others

    1984-01-01

    A 5-week family medicine clerkship is described that uses several innovative techniques: problem-based learning focusing on patient management tutorials; consultation with specialists; supervised patient care and a nursing home inpatient teaching service; and workshops on topics such as office-surgical techniques, practice management, and…

  19. Improving the National Board of Medical Examiners Internal Medicine Subject Exam for Use in Clerkship Evaluation

    PubMed Central

    Elnicki, D Michael; Lescisin, Dianne A; Case, Susan

    2002-01-01

    OBJECTIVE To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN Two-round Delphi technique. PARTICIPANTS The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS Using 1–5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM–CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician

  20. Medical Student Attitudes toward Geriatric Medicine and Patients.

    ERIC Educational Resources Information Center

    Perrotta, Peter; And Others

    1981-01-01

    The influence of factual knowledge about the aged, general attitudes toward the aged, and personal contact with the aged on first-year medical students' attitudes toward geriatric patients and geriatric medicine was examined. Entering medical students indicated a preference for working with younger patients rather than aged patients. (Author/MLW)

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Carter, William J.

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Hull, Alan L.; Kleinhenz, Mary Ellen

    1990-01-01

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

  4. Culture Competence in the Training of Geriatric Medicine Fellows

    ERIC Educational Resources Information Center

    Tanabe, Marianne K. G.

    2007-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  6. History of geriatric medicine: from Hippocrates to Marjory Warren.

    PubMed

    Ritch, A

    2012-01-01

    It is widely assumed that geriatric medicine was an invention of the twentieth century. However, from the time of Hippocrates, there has been interest in the prolongation of the lifespan, the maintenance of health in old age and agerelated disease patterns. The debate about whether old age was a natural phenomenon or a disease state was not resolved until the nineteenth century. Calls for medicine relating to old age to be recognised as a discrete entity at the time when medical specialisation was developing were disregarded until the second half of the twentieth century. This review discusses the history of the theories of ageing and of disease and the practice of medicine for older people from the classical period up to Marjory Warren's initiative in London in 1935 and the development of geriatrics as a medical specialty. PMID:23240126

  7. An Assessment of the Mastery of Entry-Level Practice Competencies Using a Primary Care Clerkship Training Model.

    ERIC Educational Resources Information Center

    Nelson, Arthur A., Jr.; Maddox, Ray R.

    1992-01-01

    A study investigated the effectiveness on entry-level skills of training six pharmacy graduate students in a primary care facility. Required clerkships in medicine, ambulatory care, and geriatrics were combined into a single rotation in a family practice ambulatory care clinic. Results were positive and have implications for improving some…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  10. Design and implementation of a longitudinal ambulatory clerkship in the first-year curriculum at the Johns Hopkins School of Medicine

    PubMed Central

    Stewart, Rosalyn; Dlhosh, Sharon; Marino, Christine; Thomas, Patricia; McGuire, Maura J.

    2011-01-01

    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. PMID:23882320

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

    PubMed Central

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

    2015-01-01

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

  12. Regulatory development of geriatric medicines: To GIP or not to GIP?

    PubMed

    De Spiegeleer, Bart; Wynendaele, Evelien; Bracke, Nathalie; Veryser, Lieselotte; Taevernier, Lien; Degroote, Agnes; Stalmans, Sofie

    2016-05-01

    Geriatric patients represent the main users of medicines, but are historically often minimally included in clinical trials, resulting in a gap in the knowledge of the benefit/risk balance of medicines in this heterogeneous population. As the worldwide population is aging, the need for safe and effective medicines for older patients is proportionally increasing. The aim of this review is to provide an overview of the current regulatory status of the development of geriatric medicines, the encountered challenges and the view of the involved stakeholders, coming to the conclusion whether it is necessary or not to implement a Geriatric Investigation Plan (GIP), by analogy with pediatrics. PMID:26899877

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

    PubMed

    Al-Aama, Tareef

    2016-06-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  16. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  18. A Conceptual Framework for Teaching Geriatrics in a Family Medicine Residency.

    ERIC Educational Resources Information Center

    Moore, James T.; Bobula, James A.

    1980-01-01

    A competency-based curriculum model for teaching geriatrics in a family medicine residency is described that divides competencies under four major goals: understanding principles, obtaining and interpreting data, managing geriatric patients, and working in a health care team. Sample objectives, instructional methods, and student evaluation are…

  19. Evaluating clinical teaching in the medicine clerkship: relationship of instructor experience and training setting to ratings of teaching effectiveness.

    PubMed

    Ramsey, P G; Gillmore, G M; Irby, D M

    1988-01-01

    A clinical teaching assessment form was used to evaluate the teaching by faculty and residents in the required third-year medicine clerkship over a two-year period. Data from 1,627 forms were analyzed for differences between groups of teachers at different experience levels and for comparison of teaching programs at different training sites. The level of involvement of instructor with student correlated with ratings by the students. Among groups of instructors, chief medical residents received the highest overall ratings. Faculty were rated higher than first-, second-, and third-year residents when degree of involvement of instructor with student was high. Ratings among faculty of different academic ranks were not significantly different. Analysis of data from different clinical settings showed that the teaching efforts by clinical faculty members in the ambulatory setting received the highest ratings from students. Although increased involvement of instructors with students or other factors may have led to the higher ratings in the ambulatory setting, the results are encouraging for the use of ambulatory teaching sites for the basic medicine clerkship. PMID:3404296

  20. Mortality meetings in geriatric medicine: strategies for improvement

    PubMed Central

    Dunbar, Joanne; George, James

    2015-01-01

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

  1. Geriatric Medicine Leadership of Health Care Transformation: To Be or Not To Be?

    PubMed Central

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

    2013-01-01

    Geriatric Medicine is well-suited to inform and lead health-care system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to “brand” Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system. PMID:24278096

  2. Abstracts From the Proceedings of the 2015 Annual Meeting of the Clerkship Directors of Internal Medicine (CDIM).

    PubMed

    Nixon, L James; Ryder, Hilary F; Alexandraki, Irene; Lyons, Maureen D; McEwen, Kelsey Angell; DeWaay, Deborah J; Warrier, Sarita; Lang, Valerie J; LaRochelle, Jeffrey

    2016-01-01

    Since its inception in 1989, Clerkship Directors in Internal Medicine (CDIM) has promoted excellence in medical student education. CDIM members move medical education forward by sharing innovations in curriculum and assessment and discoveries related to educating our students and administering our programs. The Alliance for Academic Internal Medicine, of which CDIM is a founding member, broadens the umbrella beyond student education to include five academically focused specialty organizations representing departments of medicine, teaching hospitals, and medical schools working together to advance learning, discovery, and caring. CDIM held its 2015 annual meeting at Academic Internal Medicine Week in Atlanta, Georgia. This year 36 innovation and research submissions were selected for either oral abstract or poster presentation. The quality of the presentations was outstanding this year and included many of the most important issues in medical education. The CDIM research committee selected the following seven abstracts as being of the highest quality, the most generalizable, and relevant to the readership of Teaching and Learning in Medicine. Two abstracts include information from the CDIM annual survey, which remains a rich source for answering questions about student education on a national level. Looking at trends in medical education, three of the seven selected abstracts mention entrustable professional activities. Three of the abstracts address how we assess student skill and provide them with appropriate feedback. These include two schools' approach to bringing milestones into the medical student realm, use of objective structured clinical exam for assessing clinical skill in clerkship, and what students want in terms of feedback. Four articles deal with curricular innovation. These include interprofessional education, high-value care, transitions of care, and internship preparation. We are pleased to share these abstracts, which represent the breadth and

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  4. Construct Validity of Three Clerkship Performance Assessments

    ERIC Educational Resources Information Center

    Lee, Ming; Wimmers, Paul F.

    2010-01-01

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

  5. Incorporating Geriatric Medicine Providers into the Care of the Older Adult with Cancer.

    PubMed

    Magnuson, Allison; Canin, Beverly; van Londen, G J; Edwards, Beatrice; Bakalarski, Pamela; Parker, Ira

    2016-11-01

    A significant proportion of cancer patients and survivors are age 65 and over. Older adults with cancer often have more complex medical and social needs than their younger counterparts. Geriatric medicine providers (GMPs) such as geriatricians, geriatric-trained advanced practice providers, and geriatric certified registered nurses have expertise in caring for older adults, managing complex medical situations, and optimizing function and independence for this population. GMPs are not routinely incorporated into cancer care for older adults; however, their particular skill set may add benefit at many points along the cancer care continuum. In this article, we review the role of geriatric assessment in the care of older cancer patients, highlight specific case scenarios in which GMPs may offer additional understanding and insight in the care of older adults with cancer, and discuss specific mechanisms for incorporating GMPs into oncology care. PMID:27613166

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  7. The Senior Mentor Program at Duke University School of Medicine

    ERIC Educational Resources Information Center

    Heflin, Mitchell T.

    2006-01-01

    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…

  8. Age-related geriatric medicine: relevance of special skills of geriatric medicine to elderly people admitted to hospital as medical emergencies.

    PubMed Central

    Kafetz, K; O'Farrell, J; Parry, A; Wijesuriya, V; McElligott, G; Rossiter, B; Lugon, M

    1995-01-01

    This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care. PMID:8544147

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

    PubMed Central

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

    2014-01-01

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

  10. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    PubMed

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies. PMID:22450181

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

    PubMed

    Pickard, Susan

    2014-05-01

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

  12. Anatomy of a clerkship test.

    PubMed

    Senecal, Emily L; Askew, Kim; Gorney, Barbara; Beeson, Michael S; Manthey, David E

    2010-10-01

    Written examinations are frequently used to assess medical student performance. Within emergency medicine (EM), a National Board of Medical Examiners (NBME) subject examination for EM clerkships does not exist. As a result, clerkship directors frequently generate examinations within their institution. This article reviews the literature behind the use of standardized examinations in evaluating medical student performance, describes methods for generating well-written test questions, reviews the statistical concepts of reliability and validity that are necessary to evaluate an examination, and proposes future directions for testing EM students. PMID:21199081

  13. Development and implementation of a geriatric care/case management program in a military community-based family medicine residency.

    PubMed

    Williams, C M; Petrelli, J; Murphy, M

    2000-11-01

    This article discusses how the development of a longitudinal geriatric assessment form facilitated a case management program in identifying high-risk frail elders within a military family practice clinic. A careful review of geriatric assessment tools was performed. From this review, a model geriatric assessment form was developed. A "SWOT" (strengths, weaknesses, opportunities, and threats) analysis of the family medicine department was completed to determine if the environment was ready for case management. Analysis of the SWOT data revealed that the environment was favorable for a population-based approach to case management. Results of this initial study are encouraging. The new longitudinal geriatric assessment form has assisted family practice residents in organizing problems and data while seeing elderly patients. As a direct result, higher-risk frail elders have been identified for closer evaluation and follow-up. Future goals are to measure outcomes-based data and to refine the geriatric assessment process. PMID:11143424

  14. A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement.

    PubMed

    Blain, H; Masud, T; Dargent-Molina, P; Martin, F C; Rosendahl, E; van der Velde, N; Bousquet, J; Benetos, A; Cooper, C; Kanis, J A; Reginster, J Y; Rizzoli, R; Cortet, B; Barbagallo, M; Dreinhöfer, K E; Vellas, B; Maggi, S; Strandberg, T

    2016-08-01

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society, in collaboration with the International Association of Gerontology and Geriatrics for the European Region, the European Union of Medical Specialists, and the International Osteoporosis Foundation-European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people. PMID:27299902

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

    PubMed

    Weber, Pavel; Prudius, Dana; Meluzínová, Hana

    2015-12-01

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

  16. A Comprehensive Fracture Prevention Strategy in Older Adults: The European Union Geriatric Medicine Society (EUGMS) Statement.

    PubMed

    Blain, H; Masud, T; Dargent-Molina, P; Martin, F C; Rosendahl, E; van der Velde, N; Bousquet, J; Benetos, A; Cooper, C; Kanis, J A; Reginster, J Y; Rizzoli, R; Cortet, B; Barbagallo, M; Dreinhöfer, K E; Vellas, B; Maggi, S; Strandberg, T

    2016-01-01

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people. PMID:27273355

  17. The quality of surgical clerkships.

    PubMed

    Holden, W D

    1985-06-01

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

  18. Effective Teaching Methods for Geriatric Competencies

    ERIC Educational Resources Information Center

    Strano-Paul, Lisa

    2011-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

    Since time immemorial homo sapiens are subjected to both health and diseases states and seek treatment for succor and assuagement in compromised health states. Since last two decades the progressive rise in the alternative form of treatment cannot be ignored and population seems to be dissatisfied with the conventional treatment modalities and therefore, resort to other forms of treatment, mainly complementary and alternative medicine (CAM). The use of CAM is predominantly more popular in older adults and therefore, numerous research studies and clinical trials have been carried out to investigate the effectiveness of CAM in the management of both communicable and non-communicable disease. In this current mini review, we attempt to encompass the use of CAM in chronic non-communicable diseases that are most likely seen in geriatrics. The current review focuses not only on the reassurance of good health practices, emphasizing on the holistic development and strengthening the body's defense mechanisms, but also attempts to construct a pattern of self-care and patient empowerment in geriatrics. The issues of safety with CAM use cannot be sidelined and consultation with a health care professional is always advocated to the patient. Likewise, responsibility of the health care professional is to inform the patient about the safety and efficacy issues. In order to substantiate the efficacy and safety of CAMs, evidence-based studies and practices with consolidated standards should be planned and executed. PMID:25125879

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

    PubMed Central

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

    2015-01-01

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

  2. Transitioning between Clerkship Directors

    ERIC Educational Resources Information Center

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

    2011-01-01

    Objective: The authors report on succession-planning for mid-level academic positions. Method: The authors describe the process of succession-planning between clerkship directors and the smooth transition resulting in one case. Results: Gradually transitioning allowed a new faculty person to assume the clerkship-director position with minimal…

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

    PubMed

    Blumenthal, Sandra; Bruns, Florian

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  5. Does student performance on preclinical OSCEs relate to clerkship grades?

    PubMed Central

    Chima, Margot; Dallaghan, Gary Beck

    2016-01-01

    Background Objective structured clinical examinations (OSCEs) have been used to assess the clinical competence and interpersonal skills of healthcare professional students for decades. However, the relationship between preclinical (second year or M2) OSCE grades and clerkship performance had never been evaluated, until it was explored to provide information to educators at the University of Nebraska Medical Center (UNMC). In addition, the relationship between M2 OSCE communication scores (which is a portion of the total score) and third-year (M3) Internal Medicine (IM) clerkship OSCE scores was also explored. Lastly, conflicting evidence exists about the relationship between the amount of previous clinical experience and OSCE performance. Therefore, the relationship between M3 IM clerkship OSCE scores and the timing of the clerkship in the academic year was explored. Methods Data from UNMC M2 OSCEs and M3 IM clerkship OSCEs were obtained for graduates of the 2013 and 2014 classes. Specifically, the following data points were collected: M2 fall OSCE total, M2 fall OSCE communication; M2 spring OSCE total, M2 spring OSCE communication; and M3 IM clerkship OSCE total percentages. Data were organized by class, M3 IM clerkship OSCE performance, and timing of the clerkship. Microsoft Excel and SPSS were used for data organization and analysis. Results Of the 245 records, 229 (93.5%) had data points for all metrics of interest. Significant differences between the classes of 2013 and 2014 existed for average M2 spring total, M2 spring communication, and M3 IM clerkship OSCEs. Retrospectively, there were no differences in M2 OSCE performances based on how students scored on the M3 IM clerkship OSCE. M3 IM clerkship OSCE performance improved for those students who completed the clerkship last in the academic year. Conclusions There were inconsistencies in OSCE performances between the classes of 2013 and 2014, but more information is needed to determine if this is because of

  6. Comprehensive Family Practice Clerkship in a Minority Institution

    PubMed Central

    Bang, Ki Moon; Greene, E. Josephine; Williams, Henry W.; Leath, Brenda A.; Matthews, Ruth

    1988-01-01

    A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas. PMID:3246700

  7. Geriatric nutrition.

    PubMed

    Markham, R W; Hodgkins, E M

    1989-01-01

    In recent decades, veterinary medicine has become more successful in prolonging the healthy, useful lives of pets. As a result, the practitioner spends a greater part of each practice day caring for the geriatric animal, both healthy and unhealthy. Because of their longevity, older pets are typically regular family members, with owners who seek the finest health care possible for their pets. The practice of geriatric medicine most properly should begin not when the dog or cat reaches some specific "golden" age, but rather when the wiggly, robust puppy or kitten receives its first examination. Like all parts of a sound preventive program, geriatric nutrition best follows from a well-considered juvenile and adult nutrition program. Furthermore, once it becomes senior, the "well" geriatric is as much a candidate for a diet designed especially to accommodate old age changes as is his unhealthy contemporary. In fact, evidence suggests that appropriate dietary management of the healthy, but often subclinical, patient may help postpone the signs of dysfunction and increase quality and length of life. A knowledge of the most significant nutrients and the impact of each on aging systems is now, and will become increasingly more, important to the progressive, skillful veterinarian. PMID:2646815

  8. Geriatric Rehabilitation ('Alters-Rehabilitation'): The New Challenge for Social Medicine and Science.

    ERIC Educational Resources Information Center

    Barolin, G. S.

    1996-01-01

    This discussion of geriatric rehabilitation stresses the importance of holistic and permanent rehabilitation with a fluent transition from the acute phase to the rehabilitation phase under one specialist's care and in one institution. Recommendations include mixed age groups in one ward; systematic education of relatives; follow-up rehabilitation…

  9. Clinical Nuclear Pharmacy Clerkship

    ERIC Educational Resources Information Center

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

    1977-01-01

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

  10. [Choosing wisely--against overuse in healthcare systems--activities in Germany and Austria in geriatric medicine].

    PubMed

    Gogol, Manfred; Siebenhofer, Andrea

    2016-04-01

    In 2012, the American Board of Internal Medicine (ABIM) Foundation initiated the Choosing Wisely campaign to promote discussion between physicians and patients (or proxies) on decision-making in medicine, and to reduce the use of procedures and therapies which are not necessary, or harmful to patients. The American Geriatrics Society (AGS), the American Medical Directors Association and the Society of Post-Acute and Long-Term Medicine (AMDA) participated in this initiative and both published 10 recommendations on procedures that should be discussed and avoided. Furthermore, some scientific societies have also published recommendations concerning elderly patients. As the campaign attracted considerable international attention, an International Roundtable was established in 2014. In Germany a similar initiative to address overuse and underuse was established by the German Society of Internal Medicine (DGIM) in 2015. The German Society of Geriatrics (DGG) was invited to address subjects affecting elderly patients that are of relevance to the German health care system. As a member of the Commission of the Association of the Scientific Medical Societies in Germany (AWMF), it also participated actively in the development of a methods paper on how to prepare recommendations. The German College of General Practitioners and Family Physicians (DEGAM) has developed a new guideline on this topic and in Austria preliminary activities are already underway. A clear, transparent, structured and evidence-based approach may help avoid some of the methodological weaknesses to be found in the development of the U.S. recommendations. Whereas the U.S. campaign only addresses overuse, the German campaign will also address underuse and misuse. PMID:26811241

  11. [Geriatrics - an interdisciplinary challenge].

    PubMed

    Nau, Roland; Djukic, Marija; Wappler, Manfred

    2016-06-01

    The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units. PMID:27167886

  12. Integrating Geriatrics into Medical School: Student Journaling as an Innovative Strategy for Evaluating Curriculum

    ERIC Educational Resources Information Center

    Shield, Renee R.; Farrell, Timothy W.; Nanda, Aman; Campbell, Susan E.; Wetle, Terrie

    2012-01-01

    Purpose of the study: The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer…

  13. Students' Educational Activities During Clerkship.

    ERIC Educational Resources Information Center

    O'Sullivan, Patricia S.; And Others

    1997-01-01

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

  14. [The geriatric university clinic].

    PubMed

    Stähelin, H B

    1995-01-01

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

  15. Social Determinants of Discharge Outcomes in Older People Admitted to a Geriatric Medicine Ward.

    PubMed

    Hawker, M; Romero-Ortuno, R

    2016-01-01

    The factors determining hospital discharge outcomes in older people are complex. This retrospective study was carried out in an in-patient geriatric ward over a month in 2015 and aimed to explore if self-reported feeling of loneliness and clinical frailty contribute to longer hospital stays or higher rates of readmission to hospital after discharge in the older population. Twenty-two men and twenty-five women (mean age 85.1 years) were assessed. There was a significant multivariate association between both self-reported loneliness (p=0.021) and the Clinical Frailty Scale (p=0.010) with length of stay, after adjusting for age, dementia and living alone. In multivariate analysis, patients who lived alone were more likely to be readmitted to hospital within 30 days (p=0.036). Loneliness, living alone and clinical frailty were associated with adverse discharge outcomes. Lower thresholds for referral to voluntary organisations and for psychosocial interventions in patients who report loneliness or live alone may be beneficial. PMID:27224503

  16. Gender-based education during clerkships: a focus group study

    PubMed Central

    van Leerdam, Lotte; Rietveld, Lianne; Teunissen, Doreth; Lagro-Janssen, Antoine

    2014-01-01

    Objectives One of the goals of the medical master’s degree is for a student to become a gender-sensitive doctor by applying knowledge of gender differences in practice. This study aims to investigate, from the students’ perspective, whether gender medicine has been taught in daily practice during clerkship. Methods A focus group study was conducted among 29 medical students from Radboud University, Nijmegen, The Netherlands, who had just finished either their internal medicine or surgical clerkships. Data were analyzed in line with the principles of constant comparative analysis. Results Four focus groups were conducted with 29 participating students. Clinical teachers barely discuss gender differences during students’ clerkships. The students mentioned three main explanatory themes: insufficient knowledge; unawareness; and minor impact. As a result, students feel that they have insufficient competencies to become gender-sensitive doctors. Conclusion Medical students at our institution perceive that they have received limited exposure to gender-based education after completing two key clinical clerkships. All students feel that they have insufficient knowledge to become gender-sensitive doctors. They suppose that their clinical teachers have insufficient knowledge regarding gender sensitivity, are unaware of gender differences, and the students had the impression that gender is not regarded as an important issue. We suggest that the medical faculty should encourage clinical teachers to improve their knowledge and awareness of gender issues. PMID:24600301

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

    PubMed

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

    2013-06-01

    The megathrust earthquake and the towering tsunami hit the east coast of Japan on March 11th of 2011 after intervals of 1,142 years. About 90 % of nearly 20,000 victims were drowned in devastating waves, while every town and city along the coast turned out to be a ruin. Over 400,000 people were forced to move to the evacuation centers where the evacuees slept on the floor without electricity, running water or heating systems at freezing nights. Emergency medicine, therefore, was more required during the evacuation phase than during the acute phase of the tsunami disaster. Here discussed is the phenomenon that the events happened mostly to the elderly evacuees especially in the swept area by silty polluted seawater. PMID:23855220

  18. Origins of British geriatrics.

    PubMed Central

    Howell, T. H.

    1976-01-01

    We may see from the foregoing account that British physicians have played a major part in the history of geriatric medicine. Other countries have no counterpart to J H Sheldon of Wolverhampton, whose work on the social medicine of old age was so fundamental, or George Adams of Belfast, to whom we owe such a debt of knowledge about cerebrovascular disease in the aged, or to Marjory Warren and the other pioneers mentioned above. Long may this tradition continue. PMID:785477

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

    PubMed

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

    2014-05-01

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

  20. Prerequisite competencies for third-year clerkships: an interdisciplinary approach.

    PubMed

    Matson, Christine C; Stearns, Jeffrey A; Defer, Thomas; Greenberg, Larrie; Ullian, John A

    2007-01-01

    The Collaborative Curriculum Project (CCP) is one of three components of the Family Medicine Curriculum Resource Project (FMCRP), a federally funded effort to provide resources for medical education curricula at the beginning of the 21st century. Medical educators and staff from public and private geographically distributed medical schools and national specialty organizations in family medicine, internal medicine, and pediatrics developed by consensus essential clinical competencies that all students should have by the beginning of the traditional clerkship year. These competencies are behaviorally measurable and organized into the domains used for the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Exemplary teaching, assessment, and faculty development resources are cited, and attention is given to budgetary considerations, application to diverse populations and settings, and opportunities for integration within existing courses. The CCP also developed a subset of competencies meriting higher priority than currently provided in the pre-clerkship years. These priority areas were empirically validated through a national survey of clerkship directors in six disciplines. The project's documents are not intended to prescribe curricula for any school but rather to provide curricular decision makers with suggestions regarding priorities for allocation of time and resources and detailed clinical competency statements and other resources useful for faculty developing clinical courses in the first 2 years of medical school. PMID:17186445

  1. Attitude adjustment: shaping medical students' perceptions of older patients with a geriatrics curriculum.

    PubMed

    Bensadon, Benjamin A; Teasdale, Thomas A; Odenheimer, Germaine L

    2013-11-01

    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 geriatrics clerkship 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

  2. Clinical Grading in Psychiatric Clerkships

    ERIC Educational Resources Information Center

    Briscoe, Gregory W.; Carlson, David L.; Fore Arcand, Lisa; Levine, Ruth E.; Cohen, Mitchell J.

    2006-01-01

    Objective: The clinical grade assessment is the most frequently used and heavily weighted component in the overall assessment of U.S. psychiatry clerkship students, yet the topic is understudied. The authors aimed to learn more about the nature, perceived virtues, and deficiencies of the clinical grade evaluation. Methods: A 26-item questionnaire…

  3. The Making of Careers, the Making of a Discipline: Luck and Chance in Migrant Careers in Geriatric Medicine

    ERIC Educational Resources Information Center

    Bornat, Joanna; Henry, Leroi; Raghuram, Parvati

    2011-01-01

    The geriatric specialty, unpopular among most UK born and trained medical graduates, provided an opportunity for career development and achievement for those doctors whose training had been non-standard for a variety of reasons. Migrant doctors who have played a substantive role in the UK National Health Service since its inception made an…

  4. The Senior Mentor Program at the University of South Carolina School of Medicine: An Innovative Geriatric Longitudinal Curriculum

    ERIC Educational Resources Information Center

    Roberts, Ellen; Richeson, Nancy A.; Thornhill, Joshua T., IV; Corwin, Sara J.; Eleazer, G. Paul

    2006-01-01

    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…

  5. Integrating Geriatric Content into a Medical School Curriculum: Description of a Successful Model

    ERIC Educational Resources Information Center

    Newell, Debra A.; Raji, Mukaila; Lieberman, Steven; Beach, Robert E.

    2004-01-01

    Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center…

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  7. [Preventive medicine in geriatrics].

    PubMed

    Namias, B

    2003-01-01

    This paper gives a summary of check-up and preventive recommendations for elderly. It concerns screening, vaccination, chemoprophylaxy, and counseling. It is mainly based on the recommendations of the U.S. Preventive services Task force. It approaches the screening of hypertention, visual and auditive impairment, breast, colorectal, cervical, prostate cancers, about dyslipidemia, depression, osteoporosis, vaccination against influenza, pneumococcal infection,and chemoprophylaxy by estrogen, raloxifene, acetyisalicyclic acid. There is also counseling in the prevention of falls, exercises, and diet. This summary underlines the multiple recent changes compared with the 1996 recommendations. PMID:14983902

  8. Regardless of age: Incorporating principles from geriatric medicine to improve care transitions for patients with complex needs.

    PubMed

    Arbaje, Alicia I; Kansagara, Devan L; Salanitro, Amanda H; Englander, Honora L; Kripalani, Sunil; Jencks, Stephen F; Lindquist, Lee A

    2014-06-01

    With its focus on holistic approaches to patient care, caregiver support, and delivery system redesign, geriatrics has advanced our understanding of optimal care during transitions. This article provides a framework for incorporating geriatrics principles into care transition activities by discussing the following elements: (1) identifying factors that make transitions more complex, (2) engaging care "receivers" and tailoring home care to meet patient needs, (3) building "recovery plans" into transitional care, (4) predicting and avoiding preventable readmissions, and (5) adopting a palliative approach, when appropriate, that optimizes patient and family goals of care. The article concludes with a discussion of practical aspects of designing, implementing, and evaluating care transitions programs for those with complex care needs, as well as implications for public policy. PMID:24557511

  9. Ratings of Students' Performances in a Third-Year Internal Medicine Clerkship: A Comparison between Problem-Based and Lecture-Based Curricula.

    ERIC Educational Resources Information Center

    Richards, Boyd F.; And Others

    1996-01-01

    A study compared the performances of Wake Forest University (North Carolina) medical students rotating through an internal medicine program, 88 in a problem-based curriculum and 364 in a lecture-based curriculum. Students in the problem-based curriculum received significantly higher ratings from house staff and faculty on four clinical rating…

  10. Academic geriatrics in Singapore.

    PubMed

    Wong, Chek Hooi; Landefeld, C Seth

    2011-11-01

    Singapore is one of the fastest-aging countries in the world. The proportion of adults aged 65 and older is projected to increase from 8.7% to 20% over the next 20 years. The country has developed various strategies to meet the needs of this increase in older adults. There is an acute shortage of geriatricians and a need to train more healthcare workers to care for older adults. Geriatric medicine is a relatively new specialty, and a small number of geriatricians have been tasked with providing an increasing load of clinical service, education, and research. Hence, there is a need to develop a cohesive structure of support for faculty development and retention, advanced specialty trainee recruitment, leadership in medical education, research, and clinical service to care for the rapidly aging population. In addition, geriatric medicine is primarily a hospital-based specialty in Singapore. There is still opportunity to collaborate and improve the academic and practice integration of geriatric medicine into primary care and intermediate and long-term care where it is most needed. PMID:22091794

  11. Nutraceuticals for geriatrics.

    PubMed

    Gupta, Charu; Prakash, Dhan

    2015-01-01

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

  12. Nutraceuticals for geriatrics

    PubMed Central

    Gupta, Charu; Prakash, Dhan

    2014-01-01

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

  13. An Evaluation of a Clerkship In Cardiology

    ERIC Educational Resources Information Center

    Edson, John N.; and others

    1969-01-01

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

  14. Geriatric Trauma.

    PubMed

    Reske-Nielsen, Casper; Medzon, Ron

    2016-08-01

    Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered. PMID:27475011

  15. Geriatric Resuscitation.

    PubMed

    Perera, Thomas; Cortijo-Brown, Alexis

    2016-08-01

    The geriatric population makes up a large portion of the emergency patient population. Geriatric patients have less reserve and more comorbid diseases. They are frequently on multiple medications and are more likely to require aggressive treatment during acute illness. Although it may not be obvious, it is important to recognize the signs of shock as early as possible. Special care and monitoring should be used when resuscitating the elderly. The use of bedside ultrasound and monitoring for coagulopathies are discussed. Clinicians should be constantly vigilant and reassess throughout diagnosis and treatment. Ethical considerations in this population need to be considered on an individual basis. PMID:27475009

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

    PubMed

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

    2014-01-01

    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

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

    PubMed Central

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

    2014-01-01

    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills. Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment. Success factors include continued support and investment from both organizations’ leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

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

    PubMed Central

    XIE, Minmin; JIANG, Wenhai; YANG, Haibo

    2015-01-01

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

  19. Geriatric Technician.

    ERIC Educational Resources Information Center

    Seton Hill Coll., Greensburg, PA.

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

  20. How the principles of geriatric assessment are shaping managed care.

    PubMed

    Fillit, H M; Hill, J; Picariello, G; Warburton, S

    1998-04-01

    In traditional geriatric medicine, comprehensive assessment is considered crucial to the care of frail older patients. The principles of geriatric assessment--identifying high-risk patients and targeting them for preventive interventions--are also practiced by managed care organizations (MCOs). Self-reported health surveys and administrative data are two methods used by MCOs to identify members at high risk for adverse health outcomes and functional decline who may benefit from geriatric case management. For a successful partnership with primary care physicians, it is very important that geriatric care managers should be knowledgeable in the principles of geriatric medicine. PMID:9559029

  1. A Medical Student Logbook for Streamlining Collection of Clerkship Evaluation Data.

    ERIC Educational Resources Information Center

    DaRosa, Debra A.; Folse, Roland

    A medical student logbook that was developed by the Department of Surgery at Southern Illinois University School of Medicine to improve the clerkship is described. Specific objectives of the logbook were: (1) to reinforce student habits to systematically record relevant data concerning patients for purposes of future recall and reference; (2) to…

  2. Does an AHEC-Sponsored Clerkship Experience Strengthen Medical Students' Intent to Provide Care for Medically Underserved Patients?

    PubMed

    Taylor, Jennifer D; Kiovsky, Richard D; Kayser, Ann; Kelley, Andrea

    2015-12-01

    The mission of Area Health Education Centers (AHECs) is to recruit and educate students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. We sought to determine if participation in an AHEC-sponsored family medicine clerkship experiences during medical school are significantly associated with a self-reported intent to practice primary care in a medically underserved environment upon graduation. The study was a prospective cohort study comparing third-year family medicine students with the Indiana University School of Medicine who participated in either an AHEC-sponsored family medicine clerkship to those who completed their required family medicine clerkship outside of the AHEC setting. Following the 160-h clinical clerkship, all students completed a mandatory, electronic survey and were asked to self-report their intent to the following question: "Which of the following statements best describes the impact of the family medicine clerkship on your intention to provide care to underserved patients when you complete residency training?" The question was integrated into a mandatory post-clerkship evaluation form required by the Indiana University School of Medicine, Department of Family Medicine. A Chi square test of independence as well as a multivariate logistic regression analysis was used to determine the independent association of AHEC clerkship participation and reported intent. A total of 1138 students completed the survey. There were not significant differences in age, gender, race, and ethnicity between students that completed an AHEC clerkship and those that did not. After adjusting for gender, race, and ethnicity, AHEC participants were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were found to be 1.2-3.4 times as likely to report increased intent compared to male students (95 % CI 1

  3. Guidelines for Graduate Medical Education in Geriatrics.

    ERIC Educational Resources Information Center

    Robbins, Alan S.; Beck, John C.

    1982-01-01

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

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

    SciTech Connect

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

    2015-07-15

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

  5. Geriatric medical education: developments since the American Geriatrics Society Conferences on Geriatric Education, 1976-77.

    PubMed

    Reichel, W

    1981-01-01

    This is a Report presented to and endorsed by the Board of Directors of the American Geriatrics Society (AGS). It deals with developments since the AGS Conferences on Geriatric Education, 1976-77. Summarized is the position adopted by various medical organizations and associations, including the Institute of Medicine, Federated Council for Internal Medicine, American Society of Internal Medicine, and the American Academy of Family Physicians. Their stances essentially agree with that described in the Proceedings of the 1976-77 Conferences (JAGS, November 1977). The consensus arising from discussions by organized medical groups is that creation of a new practice specialty is unnecessary, although development and maintenance of an academic cadre of teachers and researchers is essential. Called for is greater commitment at the medical school level to incorporate geriatrics into the curriculum. The Report also deals with the question of merited recognition for those with special competency or expanded training in geriatrics. Finally, the Report provides support for the Medical Director concept, and looks to the Society's new Section for Long-Term Care Physicians to provide leadership in emphasizing the role of the physician in long-term care. The AGS intends, through future reports, publications, conferences, and liaison relationships with other organizations, to continue this advance, seeking solutions designed to improve and extend the health care of the aging population. PMID:6778906

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

    PubMed

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

    2011-09-01

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

  7. Ethical dilemmas in clerkship rotations.

    PubMed

    Myers, Michael F; Herb, Alice

    2013-11-01

    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

  8. Progress in Geriatrics: A Clinical Care Update.

    ERIC Educational Resources Information Center

    Blanchette, Patricia Lanoie; And Others

    1997-01-01

    This issue includes 18 theme articles that examine clinical care, conditions, and practice as they relate to older adults. It contains articles on the following: men's and women's health, depression, dementia, hypertension, incontinence, bone pain, infections, preventive medicine, geriatric medicine, health care delivery, managed care, long-term…

  9. Implementation of an Undergraduate Nutritional Support Clerkship.

    ERIC Educational Resources Information Center

    Stennett, Douglass J.; And Others

    1983-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  11. Teaching the Multidisciplinary Team Approach in a Geriatrics Miniresidency.

    ERIC Educational Resources Information Center

    Jackson, J. Edward; And Others

    1990-01-01

    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)

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

    PubMed

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

    2002-07-01

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

  13. [Geriatric day hospital: what evidence? A systematic review].

    PubMed

    Petermans, Jean; Velghe, Anja; Gillain, Daniel; Boman, Xavier; Van Den Noortgate, Nele

    2011-09-01

    A systematic review of the international literature concerning the organisation of the Geriatric Day Hospital (GDH) was performed. From 1987 till now, few papers were found describing the activity and the effectiveness of the GDH. All the studies comparing specific geriatric approaches to regular medicine demonstrate the efficiency of geriatric care, particularly the geriatric assessment. So, with a degree of evidence 1a, a better outcome is found for patients undergoing a geriatric assessment and intervention, compared to patients having no geriatric assessment at all. However, there is no evidence of benefit for the geriatric day hospital compared to patients treated in a geriatric ward or other location of geriatric care. Moreover, there is no clear consensus on the settings and activities of a geriatric day hospital. Terms as day unit, day hospital, day care, are used interchangeably and are not always covering the same activity. The same remark can be made on the exact composition of the geriatric multidisciplinary team and its role. However nurses and paramedical workers are always mentioned as all performing geriatric assessment. The diagnostic activities on the GDH are seldom described and studied. More information is available on rehabilitation activity, often developed in specific patient populations such as stroke patients, dementia patients, cardiac patients or patients with other chronic diseases. In this selected patient populations positive effects on outcome are shown in the GDH (level of evidence 1a). Another problem is the heterogeneity of the population. For scientific reason the GDH should focus on organising care for specific medical problems. Diseases as dementia, stroke, cardiac insufficiency, could be good models to investigate the efficiency of geriatric assessment and interventions within the setting of a GDH. PMID:21896433

  14. Emerging geriatric challenge.

    PubMed

    Dhar, H L

    2005-10-01

    India is a vast country with diversity, both physical and cultural. 72% of World's second largest population live in rural experiencing varying degrees of socioeconomic change. However, there is no nationwide registry of older people and exact statistics about elderly population is not available. Community-based data on morbidity and disability are also not available. India is one of the few countries in the world where men out number women at all ages till about 70 years and only in very old age (80+) there are more women than men. One of the main social effect of extension of life in later years is the extended period of widowhood for women mainly due to cultural practice of men marrying younger women and widow marriage as well as divorce are uncommon. Much progress has been made in the health care services in the last 50 years giving much emphasis to mother and child programme with special emphasis on controlling population. But elderly population has been neglected, there is no separate ward for elderly in hospitals, no specialized courses in the Universities for training doctors and nurses for elderly care. Recently, Indian Medical Association has organized an ambitious project for rural elderly with emphasis on Geriatric care. Still recently, emphasis has been given for developing infrastructural facilities including creating training, courses on Geriatric Medicine and integrating with alternative system for better care of elderly. However, due to increasing awareness of policy makers to multiple issues related to aging, some progress has been made like old age pension scheme, income tax rebate for elderly, old homes and day care centers and law to help retired citizens in evicting tenants etc. but environment is not as elderly-friendly as in European countries, as the State is not likely to have adequate resources in the presence of other priorities in the country. PMID:16459531

  15. Medical Student Abuse During Clinical Clerkships in Japan

    PubMed Central

    Nagata-Kobayashi, Shizuko; Sekimoto, Miho; Koyama, Hiroshi; Yamamoto, Wari; Goto, Eiji; Fukushima, Osamu; Ino, Teruo; Shimada, Tomoe; Shimbo, Takuro; Asai, Atsushi; Koizumi, Shunzo; Fukui, Tsuguya

    2006-01-01

    OBJECTIVE To assess the prevalence of medical student abuse during clinical clerkships in Japan. DESIGN A cross-sectional questionnaire survey. SETTING Six medical schools in Japan. PARTICIPANTS Final year (sixth-year) and fifth-year medical students in the period from September 2003 to January 2004. From a total of 559 students solicited, 304 (54.4%) returned the questionnaire, and 276 (49.4%: 178 male and 98 female) completed it. MEASUREMENTS Prevalence of medical student abuse in 5 categories: verbal abuse, physical abuse, academic abuse, sexual harassment, and gender discrimination; differences in abusive experience between male and female students; types of alleged abusers; reporting abusive experiences to authorities; and emotional effects of abusive experiences. RESULTS Medical student abuse was reported by 68.5% of the respondents. Verbal abuse was the most frequently experienced abuse (male students 52.8%, female students 63.3%). Sexual harassment was experienced significantly more often (P<.001) by female students (54.1%) than by male students (14.6%). Faculty members were most often reported as abusers (45.2% of cases). Abuse occurred most frequently during surgical rotations (42.0% of cases), followed by internal medicine (25.1%) and anesthesia rotations (21.8%). Very few abused students reported their abusive experiences to authorities (8.5%). The most frequent emotional response to abuse was anger (27.1% of cases). CONCLUSIONS Although experience of abuse during clinical clerkships is common among medical students in Japan, the concept of “medical student abuse” is not yet familiar to Japanese. To improve the learning environment, medical educators need to take action to resolve this serious issue. PMID:16390504

  16. [Review in geriatric medicine 2013].

    PubMed

    Büla, Christophe

    2014-01-15

    Physical activity appears once again as the single most effective preventative intervention in older persons to delaying functional decline, avoiding falls, and mitigating the odds of developing dementia. Integrated care that promotes interdisciplinary collaboration among healthcare professionals is a major avenue to improve care coordination in polymorbid older patients. A study depicts the large gap between physicians and nurses' views about their respective skills and role in such a collaboration. On the cognitive side, while several studies show that new cohorts of older persons appear to age in better cognitive shape, results of trials of semagestat, a gamma-secretase inhibitor, and post-menopausal estrogenic therapy were disappointing. Finally, a study challenges the benefits of hydration in terminally ill patients. PMID:24558897

  17. Use of Standardized Patients during a Psychiatry Clerkship

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Raisch, Dennis W.; And Others

    1993-01-01

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

  19. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study

    PubMed Central

    2011-01-01

    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

  20. [Interprofessionalism in geriatrics].

    PubMed

    Mennel, Frédéric

    2014-01-01

    A system for the coordinated care of elderly people in geriatrics was set up at Luxembourg general hospital. The creation of the short-stay geriatric unit resulted in a reorganisation which questioned the notions of team, cohesion and skill. This article describes the successful experience and the benefit it has brought patients. PMID:25137960

  1. Demographics of health and disease in the geriatric horse.

    PubMed

    Paradis, Mary Rose

    2002-12-01

    Owners of older horses have generally owned them for a long time. They have developed a bond that is similar to that seen with companion animals. Their desire to have their animal(s) age gracefully with comfort and mobility has stirred research in the field of equine geriatric medicine. Equine geriatric medicine is to the first decade of the twenty-first century as neonatal medicine was to the 1980s. Hopefully, the demographics discussed in this article highlight area where research can be most helpful. PMID:12516924

  2. A Required Internal Medicine Preceptorship.

    ERIC Educational Resources Information Center

    Anderson, M. Brownell; And Others

    1982-01-01

    A preceptorship in an internal medicine clerkship at Southern Illinois University School of Medicine is discussed and evaluated. The results of a telephone survey indicate that the preceptorship had an important impact on the students, who learned time management, office management, and management of chronic clinical problems. (MLW)

  3. Teaching Medical Informatics Skills During a Clinical Clerkship

    PubMed Central

    Codish, Shlomi; Leibowitz, Akiva; Weinreb, Baruch

    2005-01-01

    Medical students use many forms of medical electronic resources (MER) during clinical clerkships. Such resources may be inaccurate, irrelevant or inappropriate, yet most medical students do not receive guidance on the use of MER. During the earliest clinical clerkship we gave a series of seminars and assignments on the use of MER. These were well accepted and were followed by increased knowledge in the use of MER. PMID:16779216

  4. Exposure and attitudes toward interprofessional teams: a three-year prospective study of longitudinal integrated clerkship versus rotation-based clerkship students.

    PubMed

    Myhre, Douglas L; Woloschuk, Wayne; Pedersen, Jeanette Somlak

    2014-05-01

    This study explored exposure to, and attitudes toward, interprofessional (IP) teams between third-year longitudinal integrated clerkship (LIC) and traditional rotation-based clerkship (RBC) students at the University of Calgary medical school. Students completed a survey pre-post 32-week LIC or 6-week rural, regional or urban RBC family medicine rotations. Pre and post rotation surveys were completed by 213 (48%) students (LIC = 33/34; rural = 76/152; regional = 24/46; urban = 80/208). More LIC students (76%) reported participating on six or more IP teams than RBC students (rural = 38%; regional = 25%; urban = 21%). At pre rotation, the mean attitude to IP teams score of LIC and rural RBC students was high and did not differ. At post rotation, the mean attitude score of LIC students was significantly greater than the mean reported by rural RBC students. Only LIC students reported a significant pre-post rotation increase in attitude. Exposure to IP teams, possibly facilitated by a longer duration of rotation, appears to be an important factor in affecting attitude to IP teams. PMID:24000879

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

    PubMed

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

    2016-03-01

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

  6. Physician and medical student perceptions and expectations of the pediatric clerkship: a Qatar experience

    PubMed Central

    Hendaus, Mohamed A; Khan, Shabina; Osman, Samar; Alsamman, Yasser; Khanna, Tushar; Alhammadi, Ahmed H

    2016-01-01

    Background The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. Objective The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. Methods An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar. Results Feedback was obtained from seven attending pediatricians (100% response rate), eight academic pediatric fellow physicians (100% response rate), 36 pediatric resident physicians (60% response rate), and 36 medical students (60% response rate). Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to students; medical students have accessibility to physicians; students are encouraged to practice evidence-based medicine; and students get adequate exposure to multi-professional teams. Conclusion Assigning devoted physicians for education, providing proper job description or definition

  7. Geriatric Medical Education in Israel

    ERIC Educational Resources Information Center

    Leibovitz, Arthur; Baumoehl, Yehuda; Habot, Beni

    2004-01-01

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

  8. [Advances in geriatric cardiology].

    PubMed

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

    2006-01-01

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

  9. Telepsychiatry and geriatric care.

    PubMed

    Jones, B N

    2001-02-01

    The use of telecommunications--telephone, computer, videoconferencing equipment--to provide mental health services at a distance has grown rapidly. This review encompasses reports from programs that provide telepsychiatry services, including telephone- and computer- based education and support services, telephone screening for dementia, and the use of videoconferencing to provide psychiatric consultations, health education, and administrative support. The extensive experience to date supports the value of telepsychiatry. Applications in geriatric settings and research involving geriatric subjects are reviewed. Cost analyses and economic evaluations of telepsychiatry are preliminary at this time and need further refinement. There is great potential for using telecommunications to expand access to mental health services to underserved geriatric populations. PMID:11177756

  10. Integrating geriatrics into clinical training, research training, board certification, and continuing education in infectious diseases: meeting review and commentary.

    PubMed

    High, K P; Joiner, K A

    1999-04-01

    Although adults aged 65 years and older constitute the most rapidly growing segment of the U.S. population, geriatric issues have not typically been a focus of training in infectious diseases (ID). Underrecognition of the unique aspects of geriatric care, apathy toward this population, and the feeling that "we're all geriatricians" (and thus know geriatric medicine) all contribute to this problem. This article summarizes the recent meeting focused on integrating geriatric principles within ID training at all levels. The ID/geriatric interface as an attractive area for basic and clinical research is emphasized. PMID:10825033

  11. Geriatric consultation services-are wards more effective than teams?

    PubMed

    Cameron, Ian D; Kurrle, Susan

    2013-01-01

    Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment. PMID:23433506

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

    ERIC Educational Resources Information Center

    Woolsey, Lisa J.

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

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

  15. Perceived Barriers and Facilitators for Academic Career in Geriatrics: Medical Students’ Perspectives

    PubMed Central

    Curran, Maureen A.; Black, Michelle; Depp, Colin A.; Iglewicz, Alana; Reichstadt, Jennifer; Palinkas, Lawrence; Jeste, Dilip V.

    2014-01-01

    Objective There is a growing concern about a shortage of physician scientists. This problem is particularly severe in certain subspecialties such as geriatrics in general and geriatric psychiatry in particular. This study sought to obtain medical students’ perspectives on barriers and facilitators toward pursuing a career in academics and/or in geriatric psychiatry or medicine. Methods The study surveyed 27 first-year medical students from six US medical schools, who had demonstrated a clear interest in academic geriatrics by completing a mentored summer research training program in geriatric medicine or geriatric psychiatry, funded by the National Institute on Aging. The survey included open-ended and close-ended questions about likely career choice and factors affecting it. Results Sixty percent of students reported they were likely to pursue an academic career, 44% a career in geriatric psychiatry or medicine, and only 36% a career in academic geriatrics. The most frequently perceived barriers were a lack of knowledge about academic careers and lack of exposure to geriatrics, financial concerns due to loan debts and low compensation, and negative impressions of research and of working with older adults. Facilitators included positive experiences with or positive impressions of research and research mentors and of older adults, and the growing demand for geriatric care. Conclusions Attracting capable and motivated medical students to academic careers in fields such as geriatric psychiatry or medicine should be a priority in seeking to expand the numbers of physician scientists and to add to the healthcare workforce in underserved subspecialty areas. Necessary approaches should include opportunities to work in academic settings, availability of sustained and dedicated mentorship, early, consistent, and positive exposure to older adults, and financial incentives. PMID:25080223

  16. American Geriatrics Society

    MedlinePlus

    ... News Membership Contact Us Site Map About Us Health Care Professionals Advocacy Public Policy Public Education Featured "If you were asked to describe geriatrics using just three words, what would they be?" Now you can wear your words with ... Shop today! New Editorial & Virtual ...

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    2015-01-01

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

  19. The need for geriatric dental education in India: the geriatric health challenges of the millennium.

    PubMed

    Thomas, Susan

    2013-06-01

    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 geriatric medicine. 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

  20. [COMPREHENSIVE GERIATRIC ASSESSMENT SCALES].

    PubMed

    Casado Verdejo, Inés; Postigo Mota, Salvador; Muñoz Bermejo, Laura; Vallejo Villalobos, José Ramón; Arrabal Léon, Nazaret; Pinto Montealegre, Jose Eduardo

    2016-01-01

    The process of comprehensive geriatric assessment is one of the key elements of geriatric care management aimed at the population. it includes evaluating the clinical, functional, mental and social aspects of aging result and/or pathological processes that appear at this stage of the life cycle. For their achievement, as well as other tools, professionals have a large number of validated rating scales specifically designed in the assessment of the different areas or fields. Its use can be very useful, especially for the objectification of evaluation results. The future of research in this area goes through deepening the adequacy of the scales to the characteristics and needs of older people in each care level or place of care. PMID:26996044

  1. Evaluating team-based, lecture-based, and hybrid learning methods for neurology clerkship in China: a method-comparison study

    PubMed Central

    2014-01-01

    Background Neurology is complex, abstract, and difficult for students to learn. However, a good learning method for neurology clerkship training is required to help students quickly develop strong clinical thinking as well as problem-solving skills. Both the traditional lecture-based learning (LBL) and the relatively new team-based learning (TBL) methods have inherent strengths and weaknesses when applied to neurology clerkship education. However, the strengths of each method may complement the weaknesses of the other. Combining TBL with LBL may produce better learning outcomes than TBL or LBL alone. We propose a hybrid method (TBL + LBL) and designed an experiment to compare the learning outcomes with those of pure LBL and pure TBL. Methods One hundred twenty-seven fourth-year medical students attended a two-week neurology clerkship program organized by the Department of Neurology, Sun Yat-Sen Memorial Hospital. All of the students were from Grade 2007, Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University. These students were assigned to one of three groups randomly: Group A (TBL + LBL, with 41 students), Group B (LBL, with 43 students), and Group C (TBL, with 43 students). The learning outcomes were evaluated by a questionnaire and two tests covering basic knowledge of neurology and clinical practice. Results The practice test scores of Group A were similar to those of Group B, but significantly higher than those of Group C. The theoretical test scores and the total scores of Group A were significantly higher than those of Groups B and C. In addition, 100% of the students in Group A were satisfied with the combination of TBL + LBL. Conclusions Our results support our proposal that the combination of TBL + LBL is acceptable to students and produces better learning outcomes than either method alone in neurology clerkships. In addition, the proposed hybrid method may also be suited for other medical clerkships that

  2. [Urosepsis in Geriatric Patients].

    PubMed

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

    2016-02-01

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

  3. Evaluation of an Outreach Activity of Pediatric Clerkship Training

    ERIC Educational Resources Information Center

    Parcel, Guy S.; And Others

    1977-01-01

    An opportunity for medical students to observe and interact with children in a setting outside the clinical environment was introduced as part of ambulatory pediatric clerkship training. Evaluation of the program indicated its overall effectiveness as well as areas for which changes are suggested. (LBH)

  4. Student Experiences with Competency Domains during a Psychiatry Clerkship

    ERIC Educational Resources Information Center

    West, Donald A.; Nierenberg, David W.

    2009-01-01

    Objectives: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and…

  5. Psychiatric Day Treatment Clerkship for Undergraduate Pharmacy Students.

    ERIC Educational Resources Information Center

    Cardoni, Alex A.; Gunning, Jacqueline

    1981-01-01

    A psychiatric day treatment clerkship for undergraduate pharmacy students at the University of Connecticut is described. Students participate in client interviewing, medication history taking, client medication counseling, medication counseling, medication clinic, medication group, and health care group. Evaluation of performance is based on both…

  6. Geriatric care in a provincial hospital.

    PubMed

    De V Meiring, P

    1977-03-26

    Much of the work of the public medical wards at Grey's Hospital is concerned with the care of aged persons. In the absence of separate geriatric facilities, this work forms an integral part of internal medicine. During the last decade two surveys, and experience gained, have determined a comprehensive approach to the social and medical problems encountered. While team work can accomplish much, the responsibility for care of the aged currently remains divided among a number of government and private agencies. Without a unified policy and further expenditure of a certain amount of money, many of our senior citizens will continue to be denied easy access to health care facilities. PMID:857323

  7. Do Geriatricians Stay in Geriatrics?

    ERIC Educational Resources Information Center

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

    2006-01-01

    To evaluate whether formally trained geriatricians remain in the field of Geriatrics, and to determine their job satisfaction and perceived quality of life, we surveyed the 107 fellows trained over the last 25 years in one accredited geriatric program. Of the 88 physicians who consented to participate, 75% devoted at least half of their practice…

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  10. Increasing Interest in Child and Adolescent Psychiatry in the Third-Year Clerkship: Results from a Post-Clerkship Survey

    ERIC Educational Resources Information Center

    Malloy, Erin; Hollar, David; Lindsey, Anthony

    2008-01-01

    Objective: The authors aimed to determine whether a structured clinical experience in child and adolescent psychiatry (CAP) during the third-year psychiatry clerkship would impact interest in pursuing careers in psychiatry and CAP. Methods: The authors constructed and administered a post-rotation survey, the Child and Adolescent Psychiatry…

  11. Geriatric assessment teams.

    PubMed

    Campbell, L J; Cole, K D

    1987-02-01

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

  12. Standpoints of traditional Persian physicians on geriatric nutrition.

    PubMed

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

    2014-10-01

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

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

    PubMed Central

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

    2014-01-01

    Purpose/Objectives Students applying to radiation oncology residency programs complete one or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first year radiation oncology resident are evaluated. Methods and Materials An anonymous, internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012–2013 academic year. The survey was composed of three main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results The survey response rate was 37% (70/188). Respondents reported 191 unique clerkship experiences. 27% of respondents (19/70) completed at least one clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent’s confidence to function as a first- year radiation oncology resident (Wilcoxon rank-sum p = 0.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman’s rho p = 0.48) or confidence to function as a first year resident (Spearman’s rho p = 0.43). Conclusions Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation

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

    SciTech Connect

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

    2014-01-01

    Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results

  15. [Antipsychotics in geriatric institutions].

    PubMed

    Szulik, Judith

    2007-01-01

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

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

    PubMed

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

    2016-04-01

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

  17. Specialist Physicians in Geriatrics—Report of the Canadian Geriatrics Society Physician Resource Work Group*

    PubMed Central

    Hogan, David B.; Borrie, Michael; Basran, Jenny F.S.; Chung, A. Maria; Jarrett, Pamela G.; Morais, José A.; Peters, Eileen; Rockwood, Kenneth J.; St. John, Philip D.; Sclater, Anne L.; Stultz, Timothy; Woolmore-Goodwin, Sarah

    2012-01-01

    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 geriatric medicine 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). PMID:23259019

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2016-04-01

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

  20. Spirituality in geriatric palliative care.

    PubMed

    Puchalski, Christina M

    2015-05-01

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

  1. Teaching Programs in Geriatric Optometry.

    ERIC Educational Resources Information Center

    Rosenbloom, Albert A.

    1985-01-01

    Results of a survey of U.S. and Canadian optometry programs concerning curriculum design, clinical and residency training programs, continuing education, and research projects planned or under way in geriatric optometry are presented and discussed. (MSE)

  2. Trauma in the geriatric population.

    PubMed

    Maxwell, Cathy A

    2015-06-01

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

  3. Studies of Medical Students' Activities on Core Surgical Clerkships: A Preliminary Report.

    ERIC Educational Resources Information Center

    Kennedy, W. Robert; Wile, Marcia Z.

    The core surgical clerkship is described as the most intensive clinical experience during the student's first three years, and one which is extremely difficult to examine systematically. The research strategy, methodologies, data collected, and major findings of a study of such clerkships are reported. The data from more than 1000 hours of…

  4. The Design and Evaluation of a Clinical Clerkship for Hospital Pharmacists.

    ERIC Educational Resources Information Center

    Belsheim, David J.; And Others

    1986-01-01

    Forty hospital pharmacists participated in a 2 week pilot of a postgraduate clinical pharmacy clerkship, using different hospital services as teaching sites at the University of Illinois and Cook County hospitals in Chicago. The clerkship experience broadened participants' conceptions of the depth and scope of the clinical pharmacist's role.…

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

    ERIC Educational Resources Information Center

    Konkin, Jill; Suddards, Carol

    2012-01-01

    Building on other models of longitudinal integrated clerkships (LIC), the University of Alberta developed its Integrated Community Clerkship with guiding principles of continuity of care, preceptor and learning environment. Professionalism is an important theme in medical education. Caring is important in professional identity formation and an…

  6. Psychiatry Clerkship Students' Preparation, Reflection, and Results on the NBME Psychiatry Subject Exam

    ERIC Educational Resources Information Center

    Briscoe, Gregory W.; Fore-Arcand, Lisa; Levine, Ruth E.; Carlson, David L.; Spollen, John J.; Pelic, Christopher; Al-Mateen, Cheryl S.

    2009-01-01

    Objective: Psychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE). Methods: Clerkship students…

  7. Effect of Curriculum Change on Exam Performance in a 4-Week Psychiatry Clerkship

    ERIC Educational Resources Information Center

    Niedermier, Julie; Way, David; Kasick, David; Kuperschmidt, Rada

    2010-01-01

    Objective: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. Methods: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject…

  8. Psychiatric OSCE Performance of Students with and without a Previous Core Psychiatry Clerkship

    ERIC Educational Resources Information Center

    Goisman, Robert M.; Levin, Robert M.; Krupat, Edward; Pelletier, Stephen R.; Alpert, Jonathan E.

    2010-01-01

    Objective: The OSCE has been demonstrated to be a reliable and valid method by which to assess students' clinical skills. An OSCE station was used to determine whether or not students who had completed a core psychiatry clerkship demonstrated skills that were superior to those who had not taken the clerkship and which areas discriminated between…

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

    ERIC Educational Resources Information Center

    Bostwick, J. Michael; Alexander, Cara

    2012-01-01

    Objective: The goal of this study was to evaluate a recent medical school curriculum change at our institution 3 years ago; specifically: shortening the Psychiatry core clerkship from 4 to 3 weeks and adding an optional 6-week core/elective combination rotation in lieu of the 3-week core. The authors aimed to determine whether clerkship length was…

  10. Geriatric dentistry education in European dental schools.

    PubMed

    Preshaw, P M; Mohammad, A R

    2005-05-01

    As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools

  11. Models of Care in Geriatric Oncology

    PubMed Central

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

    2014-01-01

    Cancer is common in older adults and the approach to cancer treatment and supportive measures in this age group is continuously evolving. Incorporating geriatric assessment (GA) into the care of the older patient with cancer has been shown to be feasible and predictive of outcomes, and there are unique aspects of the traditional geriatric domains that can be considered in this population. Geriatric assessment-guided interventions can also be developed to support patients during their treatment course. There are several existing models of incorporating geriatrics into oncology care, including a consultative geriatric assessment, geriatrician “embedded” within an oncology clinic and primary management by a dual-trained geriatric oncologist. Although a geriatrician or geriatric oncologist leads the geriatric assessment, is it truly a multidisciplinary assessment, and often includes evaluation by a physical therapist, occupational therapist, pharmacist, social worker and nutritionist. PMID:25587518

  12. [Geriatrics: an absolute necessity].

    PubMed

    Oostvogel, F J

    1982-02-01

    The medical care for elderly people could be greatly improved. If no specific attention is paid immediately, namely through the various training courses and by way of further and part-time schooling, then this medical care will remain unsatisfactory. This situation worsens continually due to the growing number of elderly people and, within this group, a much higher rate of very aged people. Increasing the care in institutions is altogether unsatisfactory. The problem should be dealt with structurally and the emphasis placed upon prevention and early-diagnosis. There is an urgent need for an integrated method, keeping in mind the limits of the elderly person, from the physical, psychological and social aspects. This demands teamwork in a multidisciplinary system inside as well as outside the institutions. It demands a thorough knowledge of geriatrics based upon gerontology. Geriatricians are urgently needed in this development together with doctors in nursing homes, general practitioners and specialists, so that the necessary care may be established as quickly as possible. PMID:7101393

  13. Geriatrics in Brazil: a big country with big opportunities.

    PubMed

    Garcez-Leme, Luiz E; Leme, Mariana Deckers; Espino, David V

    2005-11-01

    Brazil has approximately 180 million inhabitants, of whom 15.2 million are aged 60 and older and 1.9 million are aged 80 and older. By 2025, the Brazilian elderly population is expected to grow to more than 32 million. Brazil has many problems related to its geographic and population size. Great distances between major cities, marked cultural and racial heterogeneity between the various geographic regions, high poverty levels, and decreasing family size all combine to put pressure on the medical and social services that can be made available to the elder population. Less than 500 Brazilian physicians are certified as geriatricians, translating into one geriatrician for every 37,000 elderly Brazilians. Beside 15 geriatric medicine residencies a larger number of fellowship programs exist, and these programs are in high demand, with more than 20 candidates per position, indicating new opportunities for growth in elder care. In addition, geriatric initiatives such as the annual elder vaccination program and the elder statute, recently approved by the Brazilian Congress, indicate that geriatric care in Brazil is entering a new era of growth and development. Although the challenges remain great, there are opportunities for Brazilian geriatrics and gerontology. PMID:16274389

  14. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    PubMed Central

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

    2015-01-01

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

  15. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Geriatric parole. 2.78 Section 2.78... Geriatric parole. (a) Upon receipt of a report from the institution in which the prisoner is confined that a... Commission shall determine whether or not to release the prisoner on geriatric parole. Release on...

  16. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Geriatric parole. 2.78 Section 2.78... Geriatric parole. (a) Upon receipt of a report from the institution in which the prisoner is confined that a... Commission shall determine whether or not to release the prisoner on geriatric parole. Release on...

  17. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Geriatric parole. 2.78 Section 2.78... Geriatric parole. (a) Upon receipt of a report from the institution in which the prisoner is confined that a... Commission shall determine whether or not to release the prisoner on geriatric parole. Release on...

  18. 28 CFR 2.78 - Geriatric parole.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Geriatric parole. 2.78 Section 2.78... Geriatric parole. (a) Upon receipt of a report from the institution in which the prisoner is confined that a... Commission shall determine whether or not to release the prisoner on geriatric parole. Release on...

  19. FUNCTIONAL NEUROIMAGING IN GERIATRIC DEPRESSION

    PubMed Central

    Gunning, Faith M.; Smith, Gwenn S.

    2012-01-01

    Synopsis Abnormalities in specific cerebral networks likely confer vulnerability that increases the susceptibility for development of geriatric depression and impact the course of symptoms. Functional neuroimaging enables the in vivo identification of alterations in cerebral function that not only characterize disease vulnerability, but also may contribute to variability in depressive symptoms and antidepressant response. Judicious use of functional neuroimaging tools can advance pathophysiological models of geriatric depression. Furthermore, due to the age-related vulnerability of specific brain systems that have been implicated in mood disorders, geriatric depression provides a logical context within which to study the role of specific functional abnormalities in both antidepressant response and key behavioral and cognitive abnormalities of mood disorders. PMID:21536165

  20. Ageing Renal Patients: We Need More Collaboration between Geriatric Services and Nephrology Departments

    PubMed Central

    Alston, Helen; Burns, Aine

    2015-01-01

    There has been a significant increase in the number of frail older patients diagnosed with advanced chronic kidney disease (CKD) over the past thirty years. These elderly patients have high levels of comorbidity, and as a consequence the face of renal medicine is changing—There is an increasing need to focus on traditionally geriatric areas of expertise such as falls prevention and rehabilitation, and to shift our emphasis onto improving patient well-being rather than longevity. Over the past decade, many nephrologists have found that they are already acting as de facto “amateur geriatricians”. This denies patients both the benefits of specialist geriatric assessment, and equally importantly denies them access to the wider geriatric multidisciplinary team. This article describes the prevalence and underlying causes of the so-called “Geriatric Giants” in patients with advanced CKD, and discusses possible improvements in care that closer working with geriatricians could bring.

  1. Activating the knowledge-to-action cycle for geriatric care in India

    PubMed Central

    2011-01-01

    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. PMID:22136552

  2. Neuromodulation therapies for geriatric depression.

    PubMed

    Gálvez, Verònica; Ho, Kerrie-Anne; Alonzo, Angelo; Martin, Donel; George, Duncan; Loo, Colleen K

    2015-07-01

    Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed. PMID:25995098

  3. Geriatric assessment for oncologists

    PubMed Central

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

    2015-01-01

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

  4. Early Walking of Geriatric Amputees

    PubMed Central

    Devas, M. B.

    1971-01-01

    After amputation geriatric patients have been enabled to get up and walk with the help of a prosthesis, an “early walking aid.” The physiotherapist measures the patient, fits the early walking aid, and instructs him in walking. The prosthesis is simple to make, easy to apply, and allows early walking with the use of a walking frame or sticks. Thus the geriatric amputee can walk as soon after operation as his general condition allows and the surgeon wishes. ImagesFIG. 1FIG. 2 PMID:5100378

  5. Does a clerkship affect students' views of psychiatric patients?

    PubMed

    Fabrega, H

    1995-12-01

    This study deals with the views of medical students toward real psychiatric patients. The students answered seven questions about ten patients who had been interviewed by a senior faculty member. The interviews were recorded on audiovisual tapes. The questions dealt with different aspects of mental illness and included views on how laypersons would evaluate and respond to patients, what it would be like to care for the patients, and whether the patients were potentially dangerous. Answers to questions were correlated. Gender and the student's accuracy in rating psychopathology were used as independent variables to examine students' views and the possible change in these views as a result of participating in a 6-week psychiatric clerkship. The pattern of intercorrelations is reported and discussed. Negative views correlated with anticipated difficulty in caring for patients, and positive views correlated with a higher accuracy in rating psychopathology. In general, student views about mental illness were relatively impervious to the effect of a clerkship. Results are discussed in terms of prior research and knowledge about gender differences in interpersonal sensitivity. Some of the social implications of the results are discussed. PMID:8522934

  6. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  7. Geriatric Optometry Programs of Promise.

    ERIC Educational Resources Information Center

    Verma, Satya B.

    1985-01-01

    The curriculum design, philosophy, and innovation of four programs in geriatric optometry are described: the Pennsylvania College of Optometry and the colleges of Optometry at the State University of New York, University of Alabama at Birmingham, and University of Houston. (MSE)

  8. Medicines

    MedlinePlus

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

  9. Medicines

    MedlinePlus

    ... you get better. In the United States, the Food and Drug Administration is in charge of assuring ... can cause unwanted side effects or interactions with food or other medicines you may be taking. They ...

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

    ERIC Educational Resources Information Center

    Mouton, Charles P.; Parker, Robert W.

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

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

    ERIC Educational Resources Information Center

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…

  13. Exercise Promotion in Geriatric Oncology.

    PubMed

    Burhenn, Peggy S; Bryant, Ashley Leak; Mustian, Karen M

    2016-09-01

    Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals. PMID:27484061

  14. Rhinitis in the geriatric population

    PubMed Central

    2010-01-01

    The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 2030[1]. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population. PMID:20465792

  15. Geriatric Issues in Older Dialysis Patients.

    PubMed

    Bhattarai, Manoj

    2016-01-01

    Geriatric syndrome is common among older patients on dialysis. Basic knowledge about its prevalence and management is crucial for nephrologists to provide standard patient care. In busy clinical settings, up-to-date and holistic medical care can be delivered to elderly dialysis patients by collaboration of nephrology and geriatrics teams, or in part by training nephrology fellows the basics of geriatrics. [Full article available at http://rimed.org/rimedicaljournal-2016-07.asp, free with no login]. PMID:27379352

  16. [Palliative care - also in geriatrics?].

    PubMed

    Sandgathe Husebø, B; Husebø, S

    2001-10-01

    Red Cross Clinic is the largest geriatric center in Norway (240 beds). Major parts of the center are: long time geriatric ward (215 beds), rehabilitation and acute ward (25 beds), day clinic (45 patients) and a teaching and research unit. A palliative care unit (10 beds) will be opened in spring 2000. In mai 1998 a national project: Palliative care for the elderly was opened at our center. The projects main goal is to develop and support proper palliative care to all severe ill and dying patients in Norway. In a prospective study we examined 179 consecutive deaths between 1998 and 1999. Average age was 84.5. Major symptom problems were pain, dyspnoea, death-rattle and anxiety. In the last 24 hours 83% of the patients received opioids, 67% of the cases morphine (mean daily dosage 31.8 mg). 37% of the patients received scopolamine (mean daily dosage 0.8 mg), 12% benzodiazepines and 3% of the patients haloperidol. 152 (85%) of the deaths were expected, 27 (15%) unexpected. In 137 patients (77%) open, honest, frank communication with patient or their nearest kin regarding the imminent death was possible. In our experience it is a myth that the relatives want doctors to practise "maximal therapy". All old patients in geriatric clinics and nursing homes need palliative care. We have found no international textbooks of geriatrics with chapters on palliative care or textbooks on palliative care with chapters on the elderly. They need doctors and nurses who are properly trained and educated in palliative care. In most countries in Europe this training and education is not provided. PMID:11810376

  17. A user's guide to enhancing geriatrics in an undergraduate medical school curriculum: the ten-step model to winning the "geriatric game".

    PubMed

    Medina-Walpole, Annette; Clark, Nancy S; Heppard, Brian; Dannefer, Elaine; Hall, William; McCann, Robert

    2004-05-01

    In 1999, the University of Rochester School of Medicine and Dentistry committed to major restructuring of its undergraduate medical school curriculum. A distinguishing feature of this reform was the planned emphasis on and integration of several core topics or themes throughout the 4 years of the curriculum. One of these curricular themes was aging. The faculty in geriatrics was presented with an unparalleled opportunity to develop a geriatrics curriculum of major proportions through the development of an aging theme. Through a user's guide approach based on the authors' experience to date, this article identifies the 10 steps necessary to "win the geriatric game" successfully integrating an aging theme into an undergraduate medical school curriculum. Since the initiation of the aging theme, several new courses, cases, and conferences have been added or enhanced, affecting all 4 years of the curriculum. Key operational challenges included successful engagement of course directors, tracking the actual experience of the aging theme, and evaluation of students' attainment of learning objectives and eventual career choices. The authors' experience suggests that an aging theme can successfully enhance the geriatrics curricular content of undergraduate education and strongly affect students across all 4 years. This 10-step approach may serve as a model for other universities committed to integrating geriatrics across the full undergraduate medical curriculum. PMID:15086668

  18. Bloodless surgery in geriatric surgery.

    PubMed

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

    2014-01-01

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

  19. Effects of a Geriatrics Interdisciplinary Experience on Learners' Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Fitzgerald, James T.; Williams, Brent C.; Halter, Jeffrey B.; Remington, Tami L.; Foulk, Mariko A.; Persky, Neal W.; Shay, Barbara R.

    2006-01-01

    This study examines the impact of an interdisciplinary training program on knowledge and attitudes of learners from four health care programs: medicine, pharmacy, social work, and nursing. Sixty-two learners participated in a 4-day educational program (one day each week for 4 weeks) focusing on interdisciplinary geriatric care. After completing…

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

    PubMed Central

    2014-01-01

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

  1. The department of internal medicine: hub of the academic health center response to the aging imperative.

    PubMed

    Hazzard, W R

    2000-08-15

    In the 21st century, geriatrics will increasingly dominate U.S. health care as the median age of the population progressively increases. Academic departments of geriatrics have been created in nations that have already experienced this shift. As an alternative strategy that builds on traditional strengths of academic medicine in the United States, departments of internal medicine should lead a multidepartmental, pan-institutional response to the aging imperative. Recognition of gerontology and geriatric medicine as central to the missions of internal medicine in clinical care, education, and research must be increased. In the process, academic departments of internal medicine will develop a high level of geriatric expertise and will launch many programs that address this challenge. Successful development of geriatric programs will serve as a catalyst to strengthen the integration among and between generalists and subspecialists. This will entail developing optimal sites and systems of geriatric care--at different levels of care and over time--that can enhance the geriatric education of medical students, residents, fellows, and practicing physicians. The study of aging and geriatric health care will also become an integral part of departmental research, in its subspecialty divisions as well as its divisions of general internal medicine and geriatrics. This strategy is urgently recommended as both a challenge and an opportunity for all departments of internal medicine. PMID:10929171

  2. Teaching interdisciplinary geriatrics ambulatory care: a case study.

    PubMed

    Williams, Brent C; Remington, Tami L; Foulk, Mariko A; Whall, Ann L

    2006-01-01

    Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary care to learners from internal medicine, social work, pharmacy, and nursing in a geriatrics clinic at a major academic institution in the United States. Framed in a critical review of existing evidence for the effectiveness of interdisciplinary training and health care and expert recommendations, specific recommendations are made to educators interested in interdisciplinary training in ambulatory settings. PMID:16446270

  3. Cognitive Aging: What Every Geriatric Psychiatrist Should Know.

    PubMed

    Blazer, Dan G; Wallace, Robert B

    2016-09-01

    The authors of this review both served on the Institute of Medicine Committee, which produced the report "Cognitive Aging: Progress in Understanding and Opportunities for Action." In this review, the authors summarize portions of the report that are especially applicable to geriatric psychiatrists and other clinicians who work with the elderly. Cognitive aging is a universal phenomenon that must be better understood by clinicians, a trajectory across multiple cognitive functions upstream from mild neurocognitive and major neurocognitive disorders. The authors review the epidemiology, basic neurobiology, and evidence-based interventions for cognitive aging. PMID:27569270

  4. Implications of Research on the Geriatric Voice.

    ERIC Educational Resources Information Center

    Benjamin, Barbaranne J.

    Noting that the progressive aging of the American population has created a need for a body of knowledge about the vocal characteristics associated with aging, this paper provides information on geriatric voice. The first section of the paper contains a selected bibliography of materials concerning geriatric voice, including literature on the need…

  5. Enhancing Geriatric Curriculum in Nursing School

    ERIC Educational Resources Information Center

    Collins, Kevin

    2013-01-01

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

  6. Depression in Geriatric and Adult Medical Inpatients.

    ERIC Educational Resources Information Center

    Magni, Guido; And Others

    1985-01-01

    Administered two scales for the evaluation of depression to two groups of medical inpatients: adults (N=201) and geriatric subjects (N=178). Results confirmed a high presence of depressive symptoms among patients with medical problems, particularly among geriatric subjects. Factors most predictive of depressive symptoms are identified. (JAC)

  7. BRIEF REPORT: Brief Instrument to Assess Geriatrics Knowledge of Surgical and Medical Subspecialty House Officers

    PubMed Central

    Williams, Brent C; Fitzgerald, James T

    2006-01-01

    PROBLEM Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialties. METHODS A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels and pilot testing, and administered to 305 residents and fellows at 4 institutions in surgical disciplines (25% of respondents), emergency medicine (29%), medicine subspecialties (19%), internal medicine (12%), and other disciplines (15%). RESULTS Three items decreased internal reliability. The remaining 20 items covered 17 topic areas. Residents averaged 62% correct on the test. Internal consistency was appropriate (Cronbach's α coefficient = 0.60). Validity was supported by the use of expert panels to develop content, and by overall differences in scores by level of training (P<.0001) and graded improvement in test performance, with 58%, 63%, 62%, and 69% correct responses among HO1, HO2, HO3, and HO4s, respectively. CONCLUSIONS This reliable, valid measure of clinical geriatrics knowledge can be used by a wide variety of surgical and medical graduate medical education programs to guide curriculum reform or evaluate program performance to meet certification requirements. The instrument is now available on the web. PMID:16704394

  8. Neurology of the geriatric patient.

    PubMed

    Fenner, W R

    1988-05-01

    Owing to improvements in health care, more animals are living to advanced ages. Many abnormal neurologic conditions can affect these patients, but those most commonly associated with advancing years include degenerative, neoplastic, and idiopathic processes. An understanding of the "normal" age-related changes seen on a neurologic examination must be kept in mind when evaluating geriatric patients. Special care and consideration of the patient and client are often required in managing these cases, especially because treatment protocols are often unsuccessful or do not exist, resulting in a prognosis that is often poor at best. PMID:3289252

  9. Terror Medicine as Part of the Medical School Curriculum

    PubMed Central

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

    2014-01-01

    Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training. PMID:25309891

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  12. The Visiting Medical Student Clerkship Program at Mayo Clinic

    PubMed Central

    Mueller, Paul S.; McConahey, Linda L.; Orvidas, Laura J.; Jenkins, Sarah M.; Kasten, Mary J.

    2010-01-01

    OBJECTIVE: To describe the history, objectives, statistics, and initiatives used to address challenges associated with the Mayo Clinic Visiting Medical Student (VMS) Clerkship Program. MATERIALS AND METHODS: Mayo Clinic administrative records were reviewed for calendar years 1995 through 2008 to determine the effect of interventions to increase the numbers of appropriately qualified international VMSs and underrepresented minority VMSs. For numerical data, descriptive statistics were used; for comparisons, χ2 tests were performed. RESULTS: During the specified period, 4908 VMSs participated in the Mayo VMS Program (yearly mean [SD], 351 [24]). Most students were from US medical schools (3247 [66%]) and were male (3084 [63%]). Overall, 3101 VMSs (63%) applied for and 935 (30%) were appointed to Mayo Clinic residency program positions. Interventions to address the challenge of large numbers of international students who participated in our VMS program but did not apply for Mayo residency positions resulted in significantly fewer international students participating in our VMS program (P<.001), applying for Mayo residency program positions (P<.001), and being appointed to residency positions (P=.001). Interventions to address the challenge of low numbers of underrepresented minority students resulted in significantly more of these students participating in our VMS program (P=.005), applying for Mayo residency positions (P=.008), and being appointed to residency positions (P=.04). CONCLUSION: Our findings suggest that specific interventions can affect the characteristics of students who participate in VMS programs and who apply for and are appointed to residency program positions. PMID:20675510

  13. Twelve tips for designing and running longitudinal integrated clerkships

    PubMed Central

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

    2013-01-01

    Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs. PMID:23883396

  14. Visiting medical student elective and clerkship programs: a survey of US and Puerto Rico allopathic medical schools

    PubMed Central

    2010-01-01

    Background No published reports of studies have provided aggregate data on visiting medical student (VMS) programs at allopathic medical schools. Methods During 2006, a paper survey was mailed to all 129 allopathic medical schools in the United States and Puerto Rico using a list obtained from the Association of American Medical Colleges. Contents of the survey items were based on existing literature and expert opinion and addressed various topics related to VMS programs, including organizational aspects, program objectives, and practical issues. Responses to the survey items were yes-or-no, multiple-choice, fill-in-the-blank, and free-text responses. Data related to the survey responses were summarized using descriptive statistics. Results Representatives of 76 schools (59%) responded to the survey. Of these, 73 (96%) reported their schools had VMS programs. The most common reason for having a VMS program was "recruitment for residency programs" (90%). "Desire to do a residency at our institution" was ranked as the leading reason visiting medical students choose to do electives or clerkships. In descending order, the most popular rotations were in internal medicine, orthopedic surgery, emergency medicine, and pediatrics. All VMS programs allowed fourth-year medical students, and approximately half (58%) allowed international medical students. The most common eligibility requirements were documentation of immunizations (92%), previous clinical experience (85%), and successful completion of United States Medical Licensing Examination Step 1 (51%). Of the programs that required clinical experience, 82% required 33 weeks or more. Most institutions (96%) gave priority for electives and clerkships to their own students over visiting students, and a majority (78%) reported that visiting students were evaluated no differently than their own students. During academic year 2006-2007, the number of new resident physicians who were former visiting medical students ranged

  15. Hyperthyroidism in the geriatric population.

    PubMed

    Federman, D D

    1991-02-15

    Although the thyroid gland can become overactive at any age, the syndrome of hyperthyroidism changes considerably in elderly persons. The principal reason is comorbidity. The patient over age 65 is much more likely than a young adult of 20 or 25 to have one or more preexisting disorders when the thyroid becomes overactive. In the elderly, therefore, the classic picture of hyperthyroidism--the constellation of irritability, sweating, palpitations without heart disease, weight loss despite good appetite, goiter, and warm, fine skin, familiar to all physicians--may never develop. Well before it might have appeared, a milder degree of thyroid hyperfunction may become manifest because of worsening of an underlying disease. Accordingly, the recognition of the thyroid disorder is often delayed. The purpose of this article is not so much to review hyperthyroidism as to delineate the special features found in geriatric patients and to describe a simple but effective scheme of evaluation. PMID:1899255

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

    ERIC Educational Resources Information Center

    Tierney, Lawrence M., Jr.

    1986-01-01

    A summary of what is generally thought to be taught well in internal medicine and what is taught less effectively is presented. The roles of medical students are considered in that context. Teaching contributions, evaluation of teaching, problems on clerkships, and opportunities for change are discussed. (MLW)

  17. How and What Do Medical Students Learn in Clerkships? Experience Based Learning (ExBL)

    ERIC Educational Resources Information Center

    Dornan, Tim; Tan, Naomi; Boshuizen, Henny; Gick, Rachel; Isba, Rachel; Mann, Karen; Scherpbier, Albert; Spencer, John; Timmins, Elizabeth

    2014-01-01

    Clerkship education has been called a "black box" because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links…

  18. Student Pre- and Post-Evaluation of an Off-Campus Clinical Clerkship

    ERIC Educational Resources Information Center

    Campbell, R. Keith

    1975-01-01

    Describes the development and use of standardized forms found to be effective for evaluating clinical clerkship experiences of pharmacy students. Copies of the Preliminary Questionnaire and the Post-Evaluation Form are included along with the goals of the Washington State University College of Pharmacy Clinical Pharmacy Program. (JT)

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

    ERIC Educational Resources Information Center

    Miller, Joseph M.; Smith, Imogene K.

    1982-01-01

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

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

    ERIC Educational Resources Information Center

    Burgut, F. Tuna; Polan, H. Jonathan

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Chibnall, John T.; Blaskiewicz, Robert J.

    2008-01-01

    Objective: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. Methods: Students completed the Revised NEO Personality…

  2. Psychiatry in the Harvard Medical School-Cambridge Integrated Clerkship: An Innovative, Year-Long Program

    ERIC Educational Resources Information Center

    Griswold, Todd; Bullock, Christopher; Gaufberg, Elizabeth; Albanese, Mark; Bonilla, Pedro; Dvorak, Ramona; Epelbaum, Claudia; Givon, Lior; Kueppenbender, Karsten; Joseph, Robert; Boyd, J. Wesley; Shtasel, Derri

    2012-01-01

    Objective: The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. Method: A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements…

  3. Do Student Evaluations Influence the Teaching Skills of Clerkship Clinical Faculty?

    ERIC Educational Resources Information Center

    Chandrasekhar, Arcot J.; Durazo-Arvizu, Ramon; Hoyt, Amy; McNulty, John A.

    2013-01-01

    Web-based student evaluations of clinical faculty were collected over an 8-year period. There were 19,881 medical student evaluations over the 8-year period for all clinical clerkships, representing a total of 952 faculty. Students used a 5-point Likert scale to rate the teaching effectiveness of faculty. Criterion-based methods and standard…

  4. Using Multiple Assessments to Evaluate Medical Students' Clinical Ability in Psychiatric Clerkships

    ERIC Educational Resources Information Center

    Wang, Peng-Wei; Cheng, Cheng-Chung; Chou, Frank Huang-Chih; Tsang, Hin-Yeung; Chang, Yu-San; Huang, Mei-Feng; Yen, Cheng-Fang

    2011-01-01

    Background: No single assessment method can successfully evaluate the clinical ability of medical students in psychiatric clerkships; however, few studies have examined the efficacy of multiple assessments, especially in psychiatry. The aim of this study was to examine the relationship among different types of assessments of medical students'…

  5. Filling in the Gaps of Clerkship with a Comprehensive Clinical Skills Curriculum

    ERIC Educational Resources Information Center

    Veale, Pamela; Carson, Julie; Coderre, Sylvain; Woloschuk, Wayne; Wright, Bruce; McLaughlin, Kevin

    2014-01-01

    Although the clinical clerkship model is based upon sound pedagogy, including theories of social learning and situated learning, studies evaluating clinical performance of residents suggests that this model may not fully meet the learning needs of students. Here our objective was to design a curriculum to bridge the learning gaps of the existing…

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

    ERIC Educational Resources Information Center

    Schillerstrom, Jason E.; Lutz, Mary

    2013-01-01

    Objective: In order to better manage medical student absences during the psychiatry clerkship, a policy allowing students to miss up to 3 days without penalty was developed. The purpose of this study was to describe absence patterns and compare academic performance between students with and without absences. Method: Authors reviewed the academic…

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

    ERIC Educational Resources Information Center

    Retamero, Carolina; Ramchandani, Dilip

    2013-01-01

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

  8. Incorporating Active Learning into a Psychiatry Clerkship: Does It Make a Difference?

    ERIC Educational Resources Information Center

    Morreale, Mary; Arfken, Cynthia; Bridge, Patrick; Balon, Richard

    2012-01-01

    Objective: Medical students' satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  12. How and what do medical students learn in clerkships? Experience based learning (ExBL).

    PubMed

    Dornan, Tim; Tan, Naomi; Boshuizen, Henny; Gick, Rachel; Isba, Rachel; Mann, Karen; Scherpbier, Albert; Spencer, John; Timmins, Elizabeth

    2014-12-01

    Clerkship education has been called a 'black box' because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links between conditions, processes, and outcomes of clerkship education in 168 empirical papers published over 7 years and synthesised a theory of how students learn. They do so when they are given affective, pedagogic, and organisational support. Affective support comes from doctors' and many other health workers' interactions with students. Pedagogic support comes from informal interactions and modelling as well as doctors' teaching, supervision, and precepting. Organisational support comes from every tier of a curriculum. Core learning processes of observing, rehearsing, and contributing to authentic clinical activities take place within triadic relationships between students, patients, and practitioners. The phrase 'supported participation in practice' best describes the educational process. Much of the learning that results is too tacit, complex, contextualised, and individual to be defined as a set of competencies. We conclude that clerkship education takes place within relationships between students, patients, and doctors, supported by informal, individual, contextualised, and affective elements of the learned curriculum, alongside formal, standardised elements of the taught and assessed curriculum. This research provides a blueprint for designing and evaluating clerkship curricula as well as helping patients, students, and practitioners collaborate in educating tomorrow's doctors. PMID:24638146

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

    PubMed

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

    2010-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. The Faculty Learning About Geriatrics (FLAG) program: bringing together experts in geriatric nursing education.

    PubMed

    Edelstein, Janice A; Cheung, Corjena K; Voss, Jo A; Kaas, Merrie J

    2011-08-01

    Strengthening geriatric content in schools of nursing is a key initiative for the Minnesota Hartford Center of Geriatric Nursing Excellence. The first Faculty Learning About Geriatrics (FLAG) program was implemented in the summer of 2008. Selected nursing faculty from across the Upper Midwest and tribal colleges have successfully completed the FLAG program in the last 2 years. Participants completed a 5-day summer institute at the University of Minnesota and a 1-year mentorship program. The FLAG program is designed to broaden expertise in geriatric nursing through building teaching and academic leadership skills and to increase content knowledge through collaboration with academic and geriatric leaders. This article provides an overview of the educational experience of FLAG participants who have earned the title of FLAG program fellow. The perspectives of the FLAG mentors and fellows are highlighted. PMID:21598851

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

    ERIC Educational Resources Information Center

    Kantor, Bonnie S.; Myers, Michelle R.

    2006-01-01

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

  17. THE INFLAMMATION HYPOTHESIS IN GERIATRIC DEPRESSION

    PubMed Central

    Alexopoulos, George S.; Morimoto, Sarah Shizuko

    2011-01-01

    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. PMID:21370276

  18. Evaluation of geriatric changes in dogs

    PubMed Central

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

    2015-01-01

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

  19. Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project.

    PubMed

    Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence

    2016-07-01

    Improving Rural Geriatric Care through Education (iRuGCE) project, including the facilitators and challenges to its implementation. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. Rural elders are the fastest growing segment of the U.S. population, with a projected increase of 32% in the next 20 years. Shortages in geriatric-prepared workers are particularly critical in rural areas. This article describes Improving Rural Geriatric Care through Education (iRuGCE), a feasible, scalable, and collaborative continuing education project. iRuGCE was designed to improve geriatric nursing practice. Project goals were to identify, mentor, and facilitate an RN geriatric site champion in critical access hospitals (CAHs) to complete national certification in gerontological nursing, and to design a continuing education program that met the specific needs of the CAHs via delivery of three continuing education sessions per year. Evaluation of the project is promising. Preliminary results suggest that iRuGCE has a positive effect on nurse-sensitive patient satisfaction scores, such as communication with nurses, responsiveness of hospital staff, pain management, communication about medicine, discharge information, and willingness to recommend the hospital. J Contin Educ Nurs. 2016;47(7):306-313. PMID:27351262

  20. [Imaging update in geriatric oncology].

    PubMed

    Gualdi, G F; Bertini, L; Lanciotti, S; Colaiacomo, M C; Casciani, E; Polettini, E

    2004-09-01

    The cancer is a problem that plagues all the ages but the greater part of the malignant tumors hits the old persons. The more elevated incidence sites of primary tumor in geriatrical age are the prostate, the lung and the colon-rectum in the men and the breast, the colon-rectum, the lung and the stomach in the women. The imaging has made steps of giant in the last few decades, with the introduction of new equipment and methodical news so as to assure everybody early and accurated diagnosis. For the lung carcinoma great advantages have been bring to us with the introduction of CT-PET and the multislice CT, that has concurred the execution of virtual bronchoscopy. The virtual endoscopy has been applied with happening also in the screening of the carcinoma of colon-rectum, executed through CT or MR. New MR technologies have allowed perform spectroscopic studies in such organs as prostate and breast, bringing the biochemical diagnosis beyond that morphologic. The MR then turns out fundamental in the appraisal of the Patient with bone metastases thanks also to the new whole body examinations. Finally the recent technology has allowed the execution of multiorgan CT screening bringing in this way new possibilities but also new questions. PMID:15700630

  1. American Association for Geriatric Psychiatry

    MedlinePlus

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

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

    ERIC Educational Resources Information Center

    Tomkowiak, John; Gunderson, Anne

    2004-01-01

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

  3. Geriatrics Educational Outreach: A Tale of Three GRECCs

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  4. Palliative care in the ambulatory geriatric practice.

    PubMed

    Finucane, Thomas E; Nirmalasari, Olivia; Graham, Antonio

    2015-05-01

    Geriatrics and palliative care often overlap. This article focuses on 2 areas where the disciplines may differ in their approach. The first is planning for extreme illness and death, with explicit acknowledgment that limiting therapy might be a good idea. This situation is likely to have a different impact in the course of a routine geriatrics visit than in a palliative care context. The second is pain management, especially chronic pain. In patients with sharply limited life expectancy, the risk/benefit equation tilts easily toward narcotic use. In frail elders working to remain independent, the calculus may be quite different. PMID:25920055

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed Central

    Guseh, Stephanie H.; Chen, Xiaodong P.

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed

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

    2015-04-01

    Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research. PMID:25831183

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

    PubMed

    Konkin, Jill; Suddards, Carol

    2012-10-01

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

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

    PubMed Central

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

    2008-01-01

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

  12. Comprehensive Geriatric Assessment in the Office

    PubMed Central

    Pereles, Laurie R.M.; Boyle, Neil G.H.

    1991-01-01

    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 PMID:21229091

  13. Geriatric dentistry--meet the need.

    PubMed

    Issrani, Rakhi; Ammanagi, Renuka; Keluskar, Vaishali

    2012-06-01

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

  14. [The problems and outlook of geriatric pharmacology].

    PubMed

    Zapadniuk, V I

    1990-01-01

    The analysis of the molecular mechanisms underlying age-related changes in manifestations of pharmacokinetics, pharmacodynamics, therapeutic and toxic properties of drugs in the elderly is presented. The ways of their correction are discussed. The advances in the development of geriatric drugs (dekamevit, kvadevit, ampevit, orkomin, potassium glutaminate, rikavit, trimethylglycine) and the perspectives for the creation of new geroprotectors are described. PMID:2201563

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

    PubMed

    Viana, Nicola

    2012-01-01

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

  16. Geriatric Staff Training for Patient Independence.

    ERIC Educational Resources Information Center

    Hickey, Tom

    The project investigated the effectiveness of an evironmental therapy training program for geriatric mental health workers when used in two different institutional settings. Site A was a State-operated facility for psychiatric in-patient care, accommodating 2,000 patients, with emphasis on maintenance and general patient welfare. Site B, a former…

  17. Faculty Preparedness in Geriatric Optometry Education.

    ERIC Educational Resources Information Center

    Mancil, Gary L.; And Others

    1995-01-01

    A survey of chief academic officers and faculty (n=27) in 16 schools of optometry found that, since 1986, there has been a 75% increase in institutions requiring coursework in geriatric optometry and an 83% increase in those offering continuing professional education in this field. However, 67% of faculty report no formal training. Three faculty…

  18. A Health Belief Interview for Clinical Geriatrics.

    ERIC Educational Resources Information Center

    Rakowski, William; Dengiz, Alan N.

    1984-01-01

    Describes a brief nine-item interview, designed for use by practitioners. Based upon results from field-testing with 65 ambulatory geriatric patients, the instrument can be used as an aid to assess health and treatment perceptions in clinical settings. Responses to specific items may also suggest broader areas for follow-up discussion. (JAC)

  19. Geriatric obesity: evaluating the evidence for the use of flavonoids to promote weight loss.

    PubMed

    Hurt, Ryan T; Wilson, Ted

    2012-01-01

    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 to help them lose weight. One such group of supplements contains plant metabolites flavonoids, which includes catechins from tea, quercetin from fruits and vegetables, and isoflavones from soy products. Some flavonoids such as catechins and soy isoflavones can modestly reduce weight. This review examined the clinical evidence for catechins, quercetin, and soy isoflavones for the treatment of obesity and explored the mechanisms of action as related to obesity. Furthermore, flavonoids were evaluated for the treatment of obesity in geriatric populations as well as for safety concerns. PMID:22888842

  20. Natural products and supplements for geriatric depression and cognitive disorders: an evaluation of the research.

    PubMed

    Varteresian, Taya; Lavretsky, Helen

    2014-08-01

    Numerous geriatric patients are using Complementary and Alternative Medicine (CAM) for late-life mood and cognitive disorders. Natural products and supplements are a common CAM intervention which have risks and benefits of which patients should be appropriately advised. The data for omega-3 fatty acids, ginkgo biloba, SAMe, St John's wort, B vitamins and vitamin D, huperzine, caprylidene, and coconut oil will be evaluated. Since the evidence basis for natural products and supplements is limited, especially for the geriatric population, studies involving the general adult population are included to infer effects in the aging population. Despite the data available, more rigorous studies with larger sample sizes over longer periods of time are still needed. Regardless of a physician's preference to recommend various natural supplements and products, a physician could protect their patients by having an understanding of the side effects and indications for various natural products. PMID:24912606

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

    PubMed Central

    Hogan, David B.

    2011-01-01

    The Kaufman Prize has been given by the Canadian Geriatrics Society for nearly 30 years, but few Society members are aware of who Kaufman was or why the Prize was named after him. They are equally unclear about the objectives established for the Prize and how successful it has been in achieving them. This paper reviews the history of the Kaufman Prize and the eponymous A.R. Kaufman. The original objectives of the award were to encourage clinical research in geriatric medicine and to foster research interest in medical residents. Over the years the Prize has allowed the Society to both recognize and encourage excellence in age-related research among trainees. With the renaming of the Prize, now would be an opportune time for the Society to review both its objectives and its format. PMID:23251314

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

    PubMed Central

    Varteresian, Taya; Lavretsky, Helen

    2014-01-01

    Numerous geriatric patients are using Complementary and Alternative Medicine (CAM) for late-life mood and cognitive disorders. Natural products and supplements are a common CAM intervention which have risks and benefits of which patients should be appropriately advised. The data for omega-3 fatty acids, ginkgo biloba, SAMe, St John’s wort, B Vitamins and Vitamin D, huperzine, caprylidene and coconut oil will be evaluated. Since the evidence basis for natural products and supplements is limited, especially for the geriatric population. Studies involving the general adult population are included to infer effects in the aging population. Despite the data available, more rigorous studies with larger sample sizes over longer periods of time are still needed. Regardless of a physician’s preference to recommend various natural supplements and products, a physician could protect their patients by having an understanding of the side effects and indications for various natural products. PMID:24912606

  3. Development of an Evaluative Procedure for Clinical Clerkships.

    ERIC Educational Resources Information Center

    And Others; Pancorbo, Salvador

    1980-01-01

    In order to evaluate the clinical competencies of graduate pharmacy students upon the completion of a medicine rotation, an oral examination has been developed that requires students to present data and defend decisions. Objectives, responsibilities, and competencies required by the rotation and nine sample exam questions are appended. (JMD)

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

    PubMed

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

    2016-03-01

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

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

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

    2014-01-01

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

  8. Developing Leadership in Geriatric Education: An Annual Faculty Institute. Proceedings of the Summer Geriatric Institute (4th, Lexington, Kentucky, July 24-27, 1989).

    ERIC Educational Resources Information Center

    Gardner, Davis L., Ed.; Hoekelman, Margaret C., Ed.

    This document presents the proceedings of a conference on geriatric education. These papers are included: Promoting Healthy Aging: A Leadership Role for Geriatric Education; National Research Priorities in Aging; Aging with a Disability; Recent Advances in Clinical Strategies in Geriatric Education: The Role of the Geriatric Nurse in the Acute…

  9. Hemangiosarcoma in a geriatric Labrador retriever.

    PubMed

    Sharma, Diya

    2012-08-01

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

  10. Redefining the Economics of Geriatric Orthopedics

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Bonnel, Wanda; Fletcher, Kathy; Wingate, Anita

    2007-01-01

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

  12. Geriatric Patients With Fractures Below the Hip are Medically Similar to Geriatric Patients With Hip Fracture

    PubMed Central

    Uppal, Harmeeth S.; Copeland, Marilyn E.; Crist, Brett D.; Volgas, David A.

    2015-01-01

    The objective of this study was to compare a cohort of geriatric patients with operatively managed isolated fractures below the hip to a cohort of geriatric patients with operatively managed isolated hip fractures. All patients greater than 59 years of age admitted to our institution for surgical care of an isolated lower extremity fracture during a 3-year period were included. Patients were divided into 2 cohorts: BTH (fracture below the subtrochanteric region of the femur) and HIP (proximal femoral fracture at subtrochanteric region or proximal). We identified 141 patients included in cohort BTH and 205 patients included in cohort HIP. HIP patients were older (P < .01) and less obese (P < .01) but were otherwise very similar. An extensive comorbidity review revealed that the 2 cohorts were similar, with the exception of an increased incidence of dementia (P = .012) or glaucoma (P = .04) in HIP patients and of peripheral neuropathy (P = .014) in BTH patients. HIP patients were more likely to be under active antiosteoporotic medication management and were more likely to be receiving pharmacological anticoagulation at the time of admission. HIP patients and BTH patients were similar with regard to necessity of assistance with ambulation preinjury, but HIP patients were less likely to reside independently at home than were BTH patients (P < .001). HIP patients were also less likely to be discharged directly home from the hospital (P < .001). Geriatric patients with fractures below the hip are medically similar to geriatric patients with hip fracture. Medical comanagement protocols have been extensively published that improve care of geriatric patients with hip fracture; consideration should be given to similar protocol-driven medical comanagement programs for geriatric patients with fractures below the hip. PMID:26246950

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

    PubMed

    Petrovic, Mirko; Somers, Annemie; Onder, Graziano

    2016-03-01

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

  14. [Geriatric dentistry: medical problems as well as disease- and therapy-induced oral disorders].

    PubMed

    Koller, M M

    1994-03-01

    As in pediatric dentistry, management of the oral problems in elderly patients does not depend on the development of new technical skills, but rather on the knowledge of: biological, psychological and social aspects of primary (physiological or age-related) and secondary (pathological or disease-related) aging; atypical presentations of disease; multiple pathological conditions (polymorbidity, polypathophysiology, polypharmacy); an underreporting of disease; the importance of functional status; the role of an interdisciplinary team; Geriatric medicine refers to social, psychological and clinical aspects of disease in older adults. Geriatric dentistry deals with the respective aspects concerning oral diseases. Chronic conditions as well as their treatment (e.g. medication) are more common with advancing age. They may have major implications for dental practice, leading to changes in oral health behavior and attitudes of the elderly patient with sometimes detrimental effects on oral health. Therefore, different concepts in prevention, diagnosis and therapy of oral diseases are required for the oral care of older adults. Two important consequences must be considered: Firstly, the medical education of the dentist and the dental team must be improved. The dental team must become a member of the group of health-care professionals caring for an aging population (geriatric medicine) to meet the heterogeneous needs of as much as 75% of our future patients. Secondly, there is great need for education of all health-care professionals dealing with elderly patients about possible negative impacts medicine can have on oral health. Identification and diagnosis of oral disease as well as preventive measures must be stressed. PMID:8153504

  15. Effectiveness of three types of geriatric medical services: lessons for geriatric psychiatric services.

    PubMed Central

    Cole, M G

    1991-01-01

    OBJECTIVES: To determine the effectiveness of geriatric medical services, to identify the types of patients who would benefit from such services, to determine the service components related to positive outcomes and to apply pertinent findings to geriatric psychiatric services. DATA SOURCES: Two databases, MEDLINE and Health Planning and Administration, were searched for relevant articles published from January 1975 to February 1990. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Seventeen reports were located that met the following three inclusion criteria: original research, published in English or French and controlled trial (nonrandomized or randomized) of a geriatric medical service. Fifteen met the validity criteria for intervention studies established by McMaster University, Hamilton, Ont. DATA EXTRACTION: Information about study design, patient selection, interventions, outcome measures and results was systematically abstracted from each report. DATA SYNTHESIS: Abstracted data were compared and contrasted. Most of the external services and some of the hospital units were effective in reducing the number of hospital days an deaths. Consultation services were ineffective. Continuing care appeared to be related to positive outcomes. CONCLUSION: In applying these findings to geriatric psychiatric services priority should be given to the development of external services and the organization of continuing care. PMID:2025818

  16. Multiresistant pathogens in geriatric nursing – infection control in residential facilities for geriatric nursing in Germany

    PubMed Central

    Peters, Claudia; Schablon, Anja; Bollongino, Kirsten; Maaß, Monika; Kaß, Dietmar; Dulon, Madeleine; Diel, Roland; Nienhaus, Albert

    2014-01-01

    Background: The increase of multidrug-resistant organisms (MDROs) causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff. Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs. Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution. Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work. PMID:25285266

  17. Development of an Interview-Based Geriatric Depression Rating Scale.

    ERIC Educational Resources Information Center

    Jamison, Christine; Scogin, Forrest

    1992-01-01

    Developed interview-based Geriatric Depression Rating Scale (GDRS) and administered 35-item GDRS to 68 older adults with range of affective disturbance. Found scale to have internal consistency and split-half reliability comparable to those of Hamilton Rating Scale for Depression and Geriatric Depression Scale. Concurrent validity, construct…

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  19. The Filipino Nursing Students' Dilemmas in Geriatric Care

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Cruz, Andrei Angelo R.; Cruz, Angela Laurice G.; Cruz, Robert Edward D.; Cuarto, Jose Mari Nino L.

    2009-01-01

    The continually rising percentage of the elderly population and the demand for geriatric nursing care are dramatically related. While it is true that most undergraduate programs prepare nurses for the care of geriatric patients, most receive limited academic preparation in the nursing curriculum (Williams & Mezey, 2000). This is particularly true…

  20. Dental Students' Self-Assessed Competence in Geriatric Dentistry.

    ERIC Educational Resources Information Center

    Kiyak, H. Asuman; Brudvik, James

    1992-01-01

    A study of four classes of dental students (n=172) exposed to both didactic and clinical geriatric dental training found that the students perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, notably treatment planning, preventive dentistry, referrals, and providing care in alternative settings.…

  1. Pharmacists' Perceptions of Major Difficulties in Geriatric Pharmacy Practice.

    ERIC Educational Resources Information Center

    Pratt, Clara Collette; And Others

    1982-01-01

    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…

  2. Factor Analytic Composition of the Geriatric Rating Scale (GRS)

    ERIC Educational Resources Information Center

    Smith, James M.; And Others

    1977-01-01

    Ambulatory geriatric patients (N=370) were rated on the Geriatric Rating Scale and results factor analyzed. The scale was found to be composed of three factors: Withdrawal/Apathy, Antisocial Disruptive Behavior, and Deficits in Activities of Daily Living. The results help explain some of the findings regarding sex differences in previous research.…

  3. Behavioral Ratings of Health Professionals' Interactions with the Geriatric Patient.

    ERIC Educational Resources Information Center

    Adelson, R.; And Others

    1982-01-01

    Reports the reliability and validity of the Health Professional-Geriatric Patient Interaction Behavior Rating Code, an observational instrument that is used to quantify the interpersonal behaviors of health professionals in the care of the geriatric patient. Condensed 15 behavioral factors into 10 operationally defined behavioral categories.…

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Ramchandani, Dilip

    2011-01-01

    Background/Objective: The author analyzed and compared various assessment methods for assessment of medical students; these methods included clinical assessment and the standardized National Board of Medical Education (NBME) subject examination. Method: Students were evaluated on their 6-week clerkship in psychiatry by both their clinical…

  6. Inclusion of geriatric nutrition in ADA-approved undergraduate programs.

    PubMed

    Shoaf, L R; Jensen, H M

    1989-09-01

    All ADA Plan IV programs were surveyed to determine whether geriatric nutrition was included in their curriculums. Of the 268 Plan IV programs, 66% responded. Less than one-fifth of the programs offered or planned to offer a specific geriatric nutrition course. An overview of geriatric nutrition occurred most frequently in a human nutrition course. A practicum/clinical experience or a course other than nutrition most frequently provided in-depth study, if such was available. Nursing homes and congregate meal sites were the primary locations for experiences with the geriatric population. Major activities with that age group included (a) taking diet histories, (b) making nutrition assessments, and (c) providing diet instruction. In some programs, didactic and experiential training with the geriatric population may not be adequate to prepare dietetic undergraduate students to meet the health care needs of that growing segment of society. PMID:2768741

  7. Intention of nursing students to work in geriatrics.

    PubMed

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

    2015-01-01

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

  8. The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

    PubMed

    Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

    2015-02-01

    The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. PMID:25644187

  9. Financing geriatric programs in community health centers.

    PubMed Central

    Yeatts, D E; Ray, S; List, N; Duggar, B

    1991-01-01

    There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization. PMID:1908588

  10. Creation of a novel, interdisciplinary, multisite clerkship: "understanding lupus".

    PubMed

    Nambudiri, Vinod E; Newman, Lori R; Haynes, Harley A; Schur, Peter; Vleugels, Ruth Ann

    2014-03-01

    Few medical school electives include longitudinal patient care across clinical specialties and environments. Systemic lupus erythematosus represents a disease process with complex pathophysiology for students to learn from providers across medical fields, including dermatology, rheumatology, nephrology, and cardiology, in both pediatric and adult patients. Diagnosis, understanding, and management of lupus also rely heavily on basic science and clinical immunology, providing a link to the preclinical curriculum. In 2009, Harvard Medical School introduced a one-month elective course "Understanding Lupus: A Multidisciplinary Approach to Systemic Disease," designed to provide students with both outpatient and inpatient care experiences in dermatology, rheumatology, and multidisciplinary clinics at Brigham and Women's Hospital and Boston Children's Hospital. Core components of the elective include a continuity experience that allows students to attend one patient's multiple specialist visits; didactics from dermatology, rheumatology, and immunology covering evidence-based medicine and basic sciences; and clinical immunology laboratory exposure to teach serologic and auto-antibody testing methods. The authors provide lessons learned in the development of this interdisciplinary, multi-institution elective rotation, which may serve as a model at other medical schools for incorporating basic sciences into the clinical curriculum and using multidisciplinary care and varied educational settings. PMID:24448033

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  12. Abdominal Pain in the Geriatric Patient.

    PubMed

    Leuthauser, Amy; McVane, Benjamin

    2016-05-01

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

  13. Delta Alerts: Changing Outcomes in Geriatric Trauma.

    PubMed

    Wiles, Lynn L; Day, Mark D; Harris, LeAnna

    2016-01-01

    Geriatric trauma patients (GTPs) suffering minor injuries have suboptimal outcomes compared with younger populations. Patients 65 years or older account for 10% of all traumas but 28% of all trauma deaths. This trauma center established a third tier trauma alert specifically targeting GTPs at risk for poor outcomes. A Delta Alert is activated when GTPs suffer injuries that fall outside traditional trauma alert guidelines. Early identification and treatment of injuries and expedited referral to specialty groups have improved our GTPs' outcomes including decreased mortality and length of stay and increased percentage of GTPs who are discharged home. PMID:27414140

  14. Thyroid disorders in the geriatric veterinary patient.

    PubMed

    Scott-Moncrieff, J Catharine

    2012-07-01

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

  15. General practitioners’ and students’ experiences with feedback during a six-week clerkship in general practice: a qualitative study

    PubMed Central

    Gran, Sarah Frandsen; Brænd, Anja Maria; Lindbæk, Morten; Frich, Jan C.

    2016-01-01

    Objective Feedback may be scarce and unsystematic during students' clerkship periods. We wanted to explore general practitioners' (GPs) and medical students' experiences with giving and receiving supervision and feedback during a clerkship in general practice, with a focus on their experiences with using a structured tool (StudentPEP) to facilitate feedback and supervision. Design Qualitative study. Setting Teachers and students from a six-week clerkship in general practice for fifth year medical students were interviewed in two student and two teacher focus groups. Subjects 21 GPs and nine medical students. Results We found that GPs first supported students' development in the familiarization phase by exploring the students' expectations and competency level. When mutual trust had been established through the familiarization phase GPs encouraged students to conduct their own consultations while being available for supervision and feedback. Both students and GPs emphasized that good feedback promoting students' professional development was timely, constructive, supportive, and focused on ways to improve. Among the challenges GPs mentioned were giving feedback on behavioral issues such as body language and insensitive use of electronic devices during consultations or if the student was very insecure, passive, and reluctant to take action or lacked social or language skills. While some GPs experienced StudentPEP as time-consuming and unnecessary, others argued that the tool promoted feedback and learning through mandatory observations and structured questions. Conclusion Mutual trust builds a learning environment in which supervision and feedback may be given during students' clerkship in general practice. Structured tools may promote feedback, reflection and learning. Key PointsObserving the teacher and being supervised are essential components of Medical students' learning during general practice clerkships.Teachers and students build mutual trust in the

  16. Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study

    PubMed Central

    2012-01-01

    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

  17. Geriatric psycho-social history outline.

    PubMed

    Velardo, C C

    1976-10-01

    The details of a Geriatric Psycho-Social History Outline for use with the institutional aged are presented. All health care facilities require background information on the patient at the time of admission, but with long-term facilities a more comprehensive psycho-social history is needed. The Outline provides a basis for obtaining information in five categories: 1) identification (detailed, observational and attitudinal); 2) referral source; 3) background; 4) family constellation or environmental factors; and 5) finances. Its comprehensiveness requires more than one pre-admission interview. It is aimed at reducing morbidity and mortality rates following admission to long-term facilities. If the aged person becomes somewhat familiar with the institution before admission, he is less susceptible to accelerated physiologic and psycho-social deterioration and death. Because of constant growth in the field of gerontology, new and improved instruments must be devised to help carry the load. The Geriatric Psycho-Social History Outline is for use as a guide to those who require such information if they are to function at maximum efficiency. PMID:965679

  18. Why do geriatric patients visit otorhinolaryngology?

    PubMed

    Özler, Gül Soylu; Yengil, Erhan

    2016-06-01

    The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis(15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population. PMID:27304440

  19. [Clinical practice guideline: a complete geriatric evaluation].

    PubMed

    Medina-Chávez, Juan Humberto; Torres-Arreola, Laura Del Pilar; Cortés-González, Rosa María; Durán-Gómez, Verónica; Martínez-Hernández, Fernando; Esquivel-Romero, Gustavo

    2011-01-01

    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

  20. Geriatric Syndromes in Older HIV-Infected Adults

    PubMed Central

    Greene, Meredith; Covinsky, Kenneth E.; Valcour, Victor; Miao, Yinghui; Madamba, Joy; Lampiris, Harry; Cenzer, Irena Stijacic; Martin, Jeffrey; Deeks, Steven G.

    2015-01-01

    Background Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exists on these conditions in older HIV-infected adults and no studies have comprehensively examined these conditions. Methods Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression and cognitive impairment were measured in a cross-sectional study of HIV-infected adults age 50 and older who had an undetectable viral load on antiretroviral therapy (ART). We examined both HIV and non-HIV related predictors of geriatric syndromes including sociodemographics, number of co-morbidities and non-antiretroviral medications, and HIV specific variables in multivariate analyses. Results We studied 155 participants with a median age of 57 (IQR 54-62); (94%) were men. Pre-frailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir (IRR 1.16, 95% CI 1.06-1.26), non-white race (IRR 1.38, 95% CI 1.10-1.74), and increasing number of comorbidities (IRR 1.09, 95%CI 1.03-1.15) were associated with increased risk of having more geriatric syndromes. Conclusions Geriatric syndromes are common in older HIV infected adults. Treatment of comorbidities and early initiation of ART may help to prevent development of these age related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles. PMID:26009828

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

    PubMed

    Lapin, Alexander

    2008-01-01

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

  2. Global initiative for interdisciplinary approach to improve innovative clinical research and treatment outcomes in geriatrics: biological cell-based targeted drug delivery systems for geriatrics.

    PubMed

    Zhumadilov, Zhaxybay

    2013-06-01

    At the intersection of the late 20(th) century and early 21(st) century, a worldwide challenge began to emerge--how can the quality of life be improved for a steadily increasing elderly population. It is well known that elderly patients show increased susceptibility to infections and a higher incidence of co-morbidity rates. Older adults frequently demonstrate pharmacokinetic and pharmacodynamic changes promoting adverse drug reactions and complications. Analysis of world literature and practical observations indicate that new approaches are required in gerontology and geriatric medicine due to recent significant advances in biomedical science. Global interdisciplinary approaches to improve medical science and medical care services for growing elderly population are indicated. This global, interdisciplinary initiative should integrate select, tangible clinical results achieved in leading research centers and universities that are applicable in the field of geriatrics and helpful to geriatricians. Among past scientific and clinically significant study results in the field of biomedicine, one must consider targeted drug delivery systems (DDS), which are designed to minimize drug side effects, increase the efficacy of drugs, and prolong and target drug interactions with particular pathological foci in sick patients. Many review articles focus on various methods of drug encapsulation and pharmacokinetics, but not on developing clinical modalities. This article attempts to further the discussion with researchers and clinicians from various fields, as well as to encourage comprehensive and elderly patient-oriented research focused on clinical implementation of DDS, especially erythrocyte-based DDS. PMID:23496161

  3. Contemporary Systemic Therapy for Urologic Malignancies in Geriatric Patients.

    PubMed

    Zhao, Bo; Grivas, Petros D

    2015-11-01

    Current data on systemic therapy in geriatric populations with genitourinary malignancies are largely derived from retrospective analyses of prospectively conducted trials or retrospective reviews. Although extrapolation of these data to real-world patients should be cautious, patients aged 65 years or older with good functional status and minimal comorbidities seem to enjoy similar survival benefit from therapy as their younger counterparts. Chronologic age alone should generally not be used to guide management decisions. Comprehensive geriatric assessment tools and prospective studies in older adults integrating comprehensive geriatric assessment can shed light on the optimal management of urologic malignancies in this population. PMID:26476122

  4. Homocysteine and disability in hospitalized geriatric patients.

    PubMed

    Marengoni, Alessandra; Cossi, Stefania; De Martinis, Monica; Calabrese, Paolo A; Orini, Stefania; Grassi, Vittorio

    2004-08-01

    Elevated total homocysteine (tHcy) concentrations have been found to be associated with cardiovascular disease and dementia in old age. The present study was performed to identify the prevalence of hyperhomocysteinemia (HHcy) and to analyze the association between tHcy concentration and sociodemographic characteristics, nutritional parameters, and cognitive and functional status in this sample of hospitalized geriatric patients. A total of 214 patients (77% females) 65+ years old admitted into an acute care geriatric ward of an internal medical department in the Northern Italy were studied. tHcy concentration was measured using a high-performance liquid chromatography with fluorescence detection (HPLC-F). Information about nutrition (body mass index [BMI], serum albumin, cholesterol, and transferrin) was collected on admission. Functional status was investigated with the Basic Activities of Daily Living scale (ADL) and the Instrumental Activities of Daily Living scale (IADL); cognitive and affective status were assessed by the Mini-Mental State Evaluation (MMSE) and the Geriatric Depression Scale (GDS). The mean tHcy concentration was 18.4 +/- 13.1 micromol/L; 74.2% of males and 68.9% of females had HHcy (> 12 micromol/L). Sixty-four percent of patients with normal serum vitamin B12 and folate concentrations had HHcy. Elevated tHcy concentrations were associated with older age, male gender, increasing serum creatinine, lower MMSE score, and disability. The mean tHcy concentration depended on the occurrence of different diseases. Patients affected by atherosclerotic diseases, such as ischemic heart diseases, cerebrovascular diseases, and dementia had higher mean tHcy concentration than those without diagnosed vascular diseases. In multivariate analysis, vitamin B12, folate, serum albumin, creatinine, and disability emerged as factors associated with tHcy, adjusted for age, gender, education, MMSE score, and atherosclerotic diseases. Our results suggest that the

  5. Improving the quality of geriatric nursing care: enduring outcomes from the geriatric nursing education consortium.

    PubMed

    Gray-Miceli, Deanna; Wilson, Laurie Dodge; Stanley, Joan; Watman, Rachael; Shire, Amy; Sofaer, Shoshanna; Mezey, Mathy

    2014-01-01

    The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted. PMID:25455325

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

    PubMed Central

    Evans, Leigh V.; Gusberg, Richard J.

    2012-01-01

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

  7. A full revolution: offering 360 degree library services to clinical clerkship students.

    PubMed

    Skhal, Kathryn J

    2008-01-01

    In their third year, medical students transition from the classroom to the hospital. Librarians can ease this transition from assignment-based to patient-based information needs, and at the University of Iowa this takes many forms. Preparation begins in the second year with foundational instruction. Customized electronic resource centers aid in selection of specialized resources; demonstrations at clerkship orientations promote these centers; attending morning reports show a librarian on the clinical team; and exercises assess the ability to find quality answers quickly. This combination has improved the students' searching facility and their comfort with library staff. Data show student resource selection became varied and appropriate, although understanding of study designs is suboptimal. Feedback has been positive from both students and faculty. While these techniques have been successful, they are only the first step in an evolving program. PMID:19042706

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

    SciTech Connect

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

    2014-01-01

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

  9. Curricular response to increase recall and transfer of anatomical knowledge into the obstetrics/gynecology clerkship.

    PubMed

    Jurjus, Rosalyn A; Brown, Kirsten; Goldman, Ellen; Galoosian, Artin; Butera, Gisela; Krapf, Jill M

    2016-07-01

    Deficits in retention of anatomy knowledge from the preclinical years to clinical application on the wards have been well documented in the medical education literature. We developed and evaluated a web and laboratory-based curriculum to address deficits in anatomy knowledge retention and to increase anatomy knowledge recall through repetition and application of clinical concepts during the obstetrics and gynecology (Ob/Gyn) core clinical clerkship. Using principles of adult learning and instructional design, a curriculum was designed consisting of (1) interactive, case-based e-modules reviewing clinically relevant anatomical topics and (2) a hands-on laboratory session reinforcing the content of the e-modules, with the practice of clinical techniques using anatomical cadaveric dissections. The curriculum's effectiveness was evaluated by using multiple choice testing and comparing baseline and final test scores. For questions testing content directly covered in this curriculum, mean final scores increased by 14.3% (P < 0.001). In contrast, for questions not directly addressed in this curriculum, mean final scores did not increase significantly, only by 6.0% (P = 0.31). Questions related to the uterus showed the greatest gains in final scores (30.3% improvement, P = 0.002). A curriculum with web-based preparatory material and a hands-on gross anatomy laboratory session effectively addresses deficits in anatomy retention and improves anatomical knowledge recall for medical students on a clinical clerkship. In the future, the authors plan to conduct a multicenter study to further evaluate the ability of this curriculum to improve clinically relevant anatomical knowledge. Anat Sci Educ 9: 337-343. © 2015 American Association of Anatomists. PMID:26588426

  10. Applying comprehensive geriatric assessment to investigate falls.

    PubMed

    Rodgers, Geraldine

    2016-04-01

    This is the second article in a short series that presents case study examples of the use of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic assessment model designed to determine frail older people's medical and mental health status, as well as functional, social and environmental issues. When applied by nurses, it can enable individualised planning for health, safety and wellbeing. This article presents the case of an older man who had a three-month history of falls. After his most recent fall he was admitted to an emergency department, where examination identified no significant abnormal pathology, and subsequently to a nurse-led older person's clinic. The article describes how a CGA approach was adopted to assess the man, establish an underlying diagnosis of Parkinson's disease, and develop a personalised care plan to address immediate falls risk and long-term planning. PMID:27029990

  11. GRAMPS: An Automated Ambulatory Geriatric Record

    PubMed Central

    Hammond, Kenric W.; King, Carol A.; Date, Vishvanath V.; Prather, Robert J.; Loo, Lawrence; Siddiqui, Khwaja

    1988-01-01

    GRAMPS (Geriatric Record and Multidisciplinary Planning System) is an interactive MUMPS system developed for VA outpatient use. It allows physicians to effectively document care in problem-oriented format with structured narrative and free text, eliminating handwritten input. We evaluated the system in a one-year controlled cohort study. When the computer, was used, appointment times averaged 8.2 minutes longer (32.6 vs. 24.4 minutes) compared to control visits with the same physicians. Computer use was associated with better quality of care as measured in the management of a common problem, hypertension, as well as decreased overall costs of care. When a faster computer was installed, data entry times improved, suggesting that slower processing had accounted for a substantial portion of the observed difference in appointment lengths. The GRAMPS system was well-accepted by providers. The modular design used in GRAMPS has been extended to medical-care applications in Nursing and Mental Health.

  12. The Geriatric Day Hospital: A Canadian Experience

    PubMed Central

    Wolochow, Michael; Ham, Richard J.

    1986-01-01

    As geriatric day hospitals (GDHs) and assessment units (GAUs) become increasingly established as part of the Canadian medical scene, a closer definition is emerging both of the role of the family physician working in their programs and also of the role of the family physician whose patient is being assessed in their units. This paper briefly summarizes the development of GDHs and GAUs in Canada, their rationale and their objectives. A detailed account is given of such a functioning program, the Short Term Assessment and Treatment (STAT) Centre at Vancouver General Hospital. The relationships of the family physician working there as a team member are described, and the role of the community family physician whose patient is being assessed in such a program is clarified. PMID:20469452

  13. Geriatric syndromes in patients with chronic kidney disease.

    PubMed

    Gołębiowski, Tomasz; Augustyniak-Bartosik, Hanna; Weyde, Wacław; Klinger, Marian

    2016-01-01

    The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than among general population. The causes of higher prevalence of those syndromes are not well known, but uremic environment and overall renal replacement therapy may have an important impact on its progress. The patient with geriatric syndrome require comprehensive treatment as well as physical rehabilitation, psychiatric cure and support in everyday activities. Herein below we would like to review recent literature regarding to particular features of main geriatric syndromes in a group of nephrological patients. PMID:27333928

  14. Geriatric rehabilitation on an acute-care medical unit.

    PubMed

    Jackson, M F

    1984-09-01

    This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals. PMID:6567647

  15. Curricular Strategies for Geriatrics Education in a Medical School.

    ERIC Educational Resources Information Center

    Reyes-Ortiz, Carlos A.; Moreno-Macias, Carlos H.

    2001-01-01

    Discusses the following: barriers to geriatrics education, teaching strategies (such as communication with patients, acceptance of one's own aging, interdisciplinary teamwork), and curriculum design for undergraduate and graduate study. (Contains 26 references.) (SK)

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

    PubMed

    Geduldig, Emma T; Kellner, Charles H

    2016-04-01

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

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

    PubMed Central

    Frank, Christopher; Martin, Ruth Elwood

    2015-01-01

    Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees’ attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching. PMID:25825611

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

    PubMed Central

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

    2016-01-01

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

  19. Attitudes of medical students towards general practice: Effects of gender, a general practice clerkship and a modern curriculum

    PubMed Central

    Kruschinski, Carsten; Wiese, Birgitt; Eberhard, Jörg; Hummers-Pradier, Eva

    2011-01-01

    Aims: Planning a career in general practice depends on positive attitudes towards primary care. The aim of this study was to compare attitudes of medical students of a Modern Curriculum at Hannover Medical School with those of the Traditional Curriculum before (pre) and after (post) a three-week clerkship in general practice. In parallel, we aimed to analyse several other variables such as age and gender, which could influence the attitudes. Methods: Prospective survey of n=287 5th-year students. Attitudes (dependent variable, Likert-scale items) as well as socio-demographic characteristics (age, gender, rural/urban background), school leaving examination grades, former qualifications, experiences in general practice and career plans were requested. Attitudes were analysed separately according to these characteristics (e.g. career plans: general practitioner (GP)/specialist), curriculum type and pre/post the clerkship in general practice. Bi- and multivariate statistical analysis was used including a factor analysis for grouping of the attitude items. Results: Most and remarkable differences of attitudes were seen after analysis according to gender. Women appreciated general practice more than men including a greater interest in chronic diseases, communication and psychosocial aspects. The clerkship (a total of n=165 students of the “post” survey could be matched) contributed to positive attitudes of students of both gender, whereas the different curricula did not show such effects. Conclusions: Affective learning goals such as a positive attitude towards general practice have depended more on characteristics of students (gender) and effects of a clerkship in general practice than on the curriculum type (modern, traditional) so far. For the development of outcomes in medical education research as well as for the evolution of the Modern Curriculum such attitudes and other affective learning goals should be considered more frequently. PMID:21818231

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2002-12-01

    The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients. PMID:12572242

  2. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

    PubMed

    2015-11-01

    The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults. PMID:26446832

  3. [Implication of the self-help mechanism in the geriatric club (author's transl)].

    PubMed

    Martincević-Ljumanović, R

    1981-07-01

    In the paper clinical investigations are given of the implication of the self-help mechanism with the 125 members of the Geriatric club of the Clinical hospital "Dr. Mladen Stojanović" in Zagreb during the year 1979. The results show that in this phase of the development of contemporary society and medicine and prevention geriatrics self-help is the only way of care and responsibility for the health of a great number of the population. Self-help is built-in everyday life and activity of the members of the club. Elder persons take part in the permanent care of their own health through the group mechanism of self-help by helping and caring for themselves on te basis of obtained health informations, knowledge and experience with society and public health services. In time they discover factors of risk which in many cases provoke a number of chronic illness and thereby put health in danger. The perspectives of self-help are in the scientific work of various social structures and in finding out specific methods of individual and group self-help for attacking mass chronic sicknesses of contemporary civilisation. PMID:6116457

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

    PubMed

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

    2016-05-01

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

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

    PubMed

    Resnick, Neil M; Radulovich, Nichole

    2014-03-01

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

  6. A Survey of Geriatrics Courses in North American Chiropractic Programs

    PubMed Central

    Borggren, Cara L.; Osterbauer, Paul J.; Wiles, Michael R.

    2009-01-01

    Purpose: There has been a growing interest in meeting the health care needs of the anticipated “age wave.” In order to prepare for the current demographic trends, we sought to describe the status of geriatrics curricula in the 18 North American English-speaking chiropractic colleges by reviewing geriatric course syllabi. Methods: A cross-sectional survey was conducted using syllabi and catalog information solicited from each English-speaking chiropractic college in North America, collected from January 1, 2007 through June 30, 2007. Information was then summarized. Results: As of June 30, 2007, roughly 78% of colleges submitted their current geriatrics course syllabi. The remaining 4 colleges were estimated using online course catalog information. Sixty-one percent of colleges offered a course that was solely dedicated to the topic of geriatrics. Additionally, 37.5% of syllabi indicating credit load offer 4 or more credits to the course containing the geriatrics component. Also, 31.3% of courses include non-classroom clinical experience, while 50% require an independent study project that provides further geriatrics experience. Furthermore, 41.2% of reported courses classify the teaching strategies as lecture only. Conclusions: These results warrant a proposal for improved curricula in this specialty population. It is proposed that more time be dedicated for this topic, more experiential learning be required, and more clinical focus be given on the needs of this population. A restructure of curricula will provide more clinical experiences for students to better equip future doctors of chiropractic for the increase in geriatric health care needs. PMID:19390680

  7. Research ethics issues in geriatric psychiatry.

    PubMed

    Dunn, Laura B; Misra, Sahana

    2009-06-01

    Progress in geriatric psychiatric research may be impeded by lack of attention to collecting evidence relevant to ethical issues. As has been noted for some time, unless proactive work is done to identify, clarify, and remediate ethical challenges (see Table 2 for research directions), deleterious effects on research can result, including research bans, unduly overprotective stances, or inaccurate weighing of risks and benefits of research by review boards. With regard to proxy consent, a number of issues require further study. These include: how state laws address (or fail to address) research involving cognitively impaired individuals and what effects this has on research conduct; how IRBs define and weigh risks and benefits in considering research involving proxy consent; how various stakeholders, including the general public, people with disorders that may impair decision-making capacity, and proxies themselves view proxy consent for research; and to what degree proxies' research decisions reflect what patients themselves would decide. The use of advanced directives as a stand alone method for future consent is fraught with difficulties around adequate informed consent for a particular study; however, future study may clarify if such directives provide surrogates with improved understanding of their relative's overall views of the research enterprise and possibly the types of studies they would be willing to participate in even if they are no longer able to provide their own consent. In depression and suicide research, further work is needed to develop standard procedures for meeting the ethical demands of research while conducting rigorous, crucial research. PMID:19486821

  8. Ash Split Cath in geriatric dialyzed patients.

    PubMed

    Conz, P A; Catalano, C; Rizzioli, E; Normanno, M; Fabbian, F; Preciso, G

    2001-09-01

    Vascular access is the essential step in performing hemodialysis in uremic patients. In the absence of a permanent and utilizable native arterio-venous fistula, the use of a tunnelled catheter makes dialysis therapy possible. The Ash Split Cath, a recently introduced chronic hemodialysis catheter, was inserted in five patients (7.1% of our prevalent dialysis population) because of repeated venous thrombosis in three patients and a poor venous tree in two. The mean age of patients was 78 years +/- 7. The average blood flow rate was 250+/-50 ml/minute and the mean venous pressure 140mm Hg +/- 35. Recirculation determined by low flux technique was less than 2%. KT/V calculated 3 months after the catheter placement was 1.2+/-0.02. During the follow-up we did not document any infection of the exit site or related to the catheter. This device is simple to place, gives adequate dialysis treatment and is useful in geriatric dialyzed patients in whom the arterio-venous fistula can no longer be used. PMID:11693424

  9. What caring means to geriatric nurses.

    PubMed

    Shwu-Jiuan, Liu

    2004-06-01

    Caring is the major concept in nursing. The purpose of this study was to describe the meaning of caring for nurses caring for elderly patients. Parse' s phenomenology was addressed in the research design, which included four steps: participant selection, dialogical engagement, extraction-synthesis, and heuristic interpretation. By stratified sampling, 30 nurses who worked in medical-surgical wards in a general teaching hospital were selected as participants. Dialogical engagement was completed through in-depth, tape-recorded interviews on the open question, " What is the meaning of caring for you as a provider of care to the elderly? ". Data were interpreted by process of Parse' s phenomenology, which included extracting the essence, synthesizing the essence, formulating a proposition, extracting concepts, and structuring the meaning. The meaning of caring for nurses engaged in caring for the elderly was: " Through the initiative deliberation from sincerity, the nurse is to dedication by the empathy and tolerance". The core concepts of caring were: deliberation, initiative, sincerity, tolerance, empathy, and dedication. It should develop and apply the caring concept and theory actively to geriatric nursing care. PMID:15208778

  10. Altered Synchronizations among Neural Networks in Geriatric Depression

    PubMed Central

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

    2015-01-01

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

  11. Altered Synchronizations among Neural Networks in Geriatric Depression.

    PubMed

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

    2015-01-01

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

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

    PubMed Central

    Stepney, Rob

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  14. Geriatric-Focused Educational Offerings in the Department of Veterans Affairs from 1999 to 2009

    ERIC Educational Resources Information Center

    Thielke, Stephen; Tumosa, Nina; Lindenfeld, Rivkah; Shay, Kenneth

    2011-01-01

    The scope of geriatrics-related educational offerings in large health care systems, in either the target audiences or topics covered, has not previously been analyzed or reported in the professional literature. The authors reviewed the geriatrics-related educational sessions that were provided between 1999 and 2009 by the Geriatrics Research,…

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

    ERIC Educational Resources Information Center

    Simonson, William; Pratt, Clara Collette

    1982-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    PubMed Central

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

    2014-01-01

    Introduction The need to train physicians committed to learning throughout their careers has prompted medical schools to encourage the development and practice of self-regulated learning by students. Longitudinal integrated clerkships (LICs) require students to exercise self-regulated learning skills. As mobile tools, tablets can potentially support self-regulation among LIC students. Methods We provided 15 LIC students with tablet computers with access to the electronic health record (EHR), to track their patient cohort, and a multiplatform online notebook, to support documentation and retrieval of self-identified clinical learning issues. Students received a 1-hour workshop on the relevant features of the tablet and online notebook. Two focus groups with the students were used to evaluate the program, one early and one late in the year and were coded by two raters. Results Students used the tablet to support their self-regulated learning in ways that were unique to their learning styles and increased access to resources and utilization of down-time. Students who used the tablet to self-monitor and target learning demonstrated the utility of tablets as learning tools. Conclusions LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students’ ability to develop and employ self-regulatory skills in a clinical context. PMID:24646438

  18. Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship.

    PubMed

    van der Zwet, J; Zwietering, P J; Teunissen, P W; van der Vleuten, C P M; Scherpbier, A J J A

    2011-08-01

    Workplace learning in undergraduate medical education has predominantly been studied from a cognitive perspective, despite its complex contextual characteristics, which influence medical students' learning experiences in such a way that explanation in terms of knowledge, skills, attitudes and single determinants of instructiveness is unlikely to suffice. There is also a paucity of research which, from a perspective other than the cognitive or descriptive one, investigates student learning in general practice settings, which are often characterised as powerful learning environments. In this study we took a socio-cultural perspective to clarify how students learn during a general practice clerkship and to construct a conceptual framework that captures this type of learning. Our analysis of group interviews with 44 fifth-year undergraduate medical students about their learning experiences in general practice showed that students needed developmental space to be able to learn and develop their professional identity. This space results from the intertwinement of workplace context, personal and professional interactions and emotions such as feeling respected and self-confident. These forces framed students' participation in patient consultations, conversations with supervisors about consultations and students' observation of supervisors, thereby determining the opportunities afforded to students to mind their learning. These findings resonate with other conceptual frameworks and learning theories. In order to refine our interpretation, we recommend that further research from a socio-cultural perspective should also explore other aspects of workplace learning in medical education. PMID:21188514

  19. [Electrolyte disturbances in geriatric patients with focus on hyponatremia].

    PubMed

    Grundmann, F

    2016-08-01

    Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia. Hypernatremia often only results in unspecific symptoms but the condition is associated with a clearly increased mortality. As electrolyte disturbances have a high prevalence in the geriatric population and can contribute to geriatric syndromes and frailty, relevant electrolyte alterations should be excluded in all geriatric patients, in particular after a change in medication schedules. PMID:27464739

  20. Increasing geriatric social work content through university/community partnerships.

    PubMed

    McCaslin, Rosemary; Barnstable, Cherie Lynn

    2008-01-01

    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 (Gero Rich), funded by the Hartford Foundation, that sought to infuse geriatric content throughout the foundation curricula of B.S.W. and M.S.W. programs. Using both quantitative and qualitative analyses, the structures and functions of the programs' university/community partnerships were examined along with their association with the sustainability of curriculum change efforts. Findings suggest that these partnerships were a critical component in increasing and sustaining geriatric curricular content and were beneficial for faculty, students, and agencies. PMID:19042224

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

    PubMed

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

    2015-09-15

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

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

    PubMed

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

    2011-09-01

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

  3. [Health care of geriatric patients with urinary incontinence].

    PubMed

    Mueller, Edgar A; Kirch, Wilhelm

    2015-04-01

    Urinary incontinence occurs frequently in geriatric patients. In the doctor's practice, the symptoms are often not mentioned by the patients; this may lead to loss of autonomy and social isolation. A screening for urinary incontinence should therefore be part of each geriatric assessment. In the presence of urinary incontinence, several treatment options are available, which need to be tailored according to the individual capabilities (mobility, motivation and cognitive performance) of the patient. Non-pharmacological treatment options, such as behavior modification, toilet training and pelvic floor training, should be exploited before any pharmacotherapy commences. If the pharmacological treatment involves the use of anticholinergic agents, the cognitive performance should be monitored. An interdisciplinary collaboration is a prerequisite for the optimized treatment and adequate health care of geriatric patients with urinary incontinence. PMID:25826038

  4. Economic viability of geriatric hip fracture centers.

    PubMed

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

    2013-12-01

    Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers. PMID:24579222

  5. Quality of Care Delivered Before versus After A Quality Improvement Intervention for Acute Geriatric Trauma

    PubMed Central

    Min, Lillian; Cryer, Henry; Chan, Chiao-Li; Roth, Carol; Tillou, Areti

    2014-01-01

    Background Older trauma injury patients had improved recovery after we implemented routine geriatric consultation for patients ≥ age 65 at a level-1 academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. Study Design Prospective observation comparing medical care after (December 2007-November 2009) versus before (December 2006-November 2007) implementation of the geriatric consult-based intervention. To measure quality-of-care (QOC) we used 33 previously-validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 Geriatric Consult [GC] versus 71 control group patients. As pre-specified subgroup analyses, we aggregated QIs by type: geriatric (e.g., delirium screening) versus non-geriatric condition-based care (e.g., thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and non-geriatric QOC scores for each patient (# QIs passed/# QIs eligible), and compared patient-level QOC for the GC versus control group, adjusting for age, gender, ethnicity, comorbidity, and injury severity. Results 63% of the GC versus 11% of the control group patients received a geriatric consultation. We evaluated 2505 QIs overall (1664 geriatric-type and 841 non-geriatric QIs). In general, fewer geriatric-type QIs were passed than non-geriatric QIs (71% vs 81%, p<.001). We provided better overall-QOC to the GC (77%) than control group patients (73%, p<.05). However, the difference was not statistically significant after multivariable adjustment (p=.08). We improved geriatric-QOC for the GC (74%) compared to the control group (68%, p<.01), a difference that was significant after multivariable adjustment (p=.01). Conclusion Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients. PMID:25840534

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

    PubMed Central

    Bieniek, Joanna; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

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

  7. A systematic approach to pharmacotherapy for geriatric major depression.

    PubMed

    Mulsant, Benoit H; Blumberger, Daniel M; Ismail, Zahinoor; Rabheru, Kiran; Rapoport, Mark J

    2014-08-01

    The broadening use of antidepressants among older Americans has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. The authors propose that the effectiveness of antidepressants depends in large part on the way they are used. Evidence supports that antidepressant pharmacotherapy leads to better outcomes when guided by a treatment algorithm as opposed to attempting to individualize treatment. Several published guidelines and pharmacotherapy algorithms developed for the treatment of geriatric depression are reviewed, and an updated algorithm proposed. PMID:25037293

  8. Need for geriatric dentistry training programs in Iran.

    PubMed

    Mir, Arash Poorsattar Bejeh

    2013-01-01

    A shifting pattern from communicable diseases to the chronic noncommunicable diseases and increased life expectancy are being sensed throughout the world. Aged populations with multiple chronic diseases come up with their unique needs and require specific attention to be challenged by the health systems. Neglected orodental facts among the elders and the dearth of specific designated undergraduate and postgraduate courses of geriatric dentistry in Iran inevitably adversely affect the delivery of appropriate dental care service to elders by untrained dentists. In this article, a proposal for academic geriatric dentistry courses in Iran is introduced and highlighted with regards to elders' special needs. PMID:23314475

  9. Measuring anxiety in late life: a psychometric examination of the geriatric anxiety inventory and geriatric anxiety scale.

    PubMed

    Gould, Christine E; Segal, Daniel L; Yochim, Brian P; Pachana, Nancy A; Byrne, Gerard J; Beaudreau, Sherry A

    2014-12-01

    We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults. PMID:25271176

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2016-01-01

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

  13. Preparation courses for medical clerkships and the final clinical internship in medical education – The Magdeburg Curriculum for Healthcare Competence

    PubMed Central

    Spura, Anke; Werwick, Katrin; Feißel, Annemarie; Gottschalk, Marc; Winkler-Stuck, Kirstin; Robra, Bernt-Peter; Braun-Dullaeus, Rüdiger C.; Stieger, Philipp

    2016-01-01

    Background/Goals: Supporting medical students entering their internships – the clinical clerkship and the internship “final clinical year” (Praktisches Jahr, PJ) – the seminars “Ready for Clerkship” and “Ready for PJ” were held for the first time in 2014 and continued successfully in 2015. These seminars are part of the “Magdeburg Curriculum for Healthcare Competence” (Magdeburger Curriculum zur Versorgungskompetenz, MCV). The concept comprises three main issues: “Understanding interdisciplinary clinical procedures”, “Interprofessional collaboration”, and “Individual cases and their reference to the system.” The aim of the seminar series is to prepare students as medical trainees for their role in the practice-oriented clinical clerkship and PJ, respectively. Methods: Quality assurance evaluations and didactic research are integral parts of the seminars. In preparation for the “Ready for PJ” seminar a needs assessment was conducted. The seminars were rated by the participants using an anonymized questionnaire consisting of a 5-choice Likert scale (ranging from 1=fully agree to 5=fully disagree) and spaces for comments that was generated by the evaluation software Evasys. Results: The results are presented for the preparatory seminars “Ready for Clerkship” and “Fit für PJ” held in 2014 and 2015. Overall, the students regarded the facultative courses as very good preparation for the clerkship as well as for the PJ. The three-dimensional main curricular concept of the MCV was recognized in the evaluation as a valuable educational approach. Interprofessional collaboration, taught by instructors focussing in teamwork between disciplines, was scored positively and highly valued. Conclusions: The “Magdeburg Curriculum for Healthcare Competence” (MCV) integrates clerkship and PJ in a framing educational concept and allows students a better appreciation of their role in patient care and the tasks that they will face. The MCV

  14. Acute lower gastrointestinal hemorrhages in geriatric patients.

    PubMed

    Ríos, Antonio; Montoya, Mariano J; Rodríguez, José Manuel; Serrano, Andrés; Molina, Joaquín; Parrilla, Pascual

    2005-05-01

    Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative

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

    PubMed Central

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

    2015-01-01

    Background Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. Objectives This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor’s accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. Methods A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy

  16. A Reliability Generalization Study of the Geriatric Depression Scale.

    ERIC Educational Resources Information Center

    Kieffer, Kevin M.; Reese, Robert J.

    2002-01-01

    Conducted a reliability generalization study of the Geriatric Depression Scale (T. Brink and others, 1982). Results from this investigation of 338 studies shows that the average score reliability across studies was 0.8482 and identifies the most important predictors of score reliability. (SLD)

  17. Confirmatory Factor Analysis of the Geriatric Depression Scale

    ERIC Educational Resources Information Center

    Adams, Kathryn Betts; Matto, Holly C.; Sanders, Sara

    2004-01-01

    Purpose: The Geriatric Depression Scale (GDS) is widely used in clinical and research settings to screen older adults for depressive symptoms. Although several exploratory factor analytic structures have been proposed for the scale, no independent confirmation has been made available that would enable investigators to confidently identify scores…

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

    ERIC Educational Resources Information Center

    Shapiro, Johanna; Cho, Beverly

    2011-01-01

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

  19. Maximizing the Potential of Internships in Gerontology and Geriatrics

    ERIC Educational Resources Information Center

    Karasik, Rona J.

    2009-01-01

    Internships and similar applied opportunities have long been valued for providing students with opportunities for practical experience, career preparation, and personal growth. The need for applied experiences in gerontology and geriatrics is particularly salient. Creating and sustaining effective internship experiences, however, requires careful…

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

    PubMed

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

    2006-02-01

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

  1. Family Perceptions of Geriatric Foster Family and Nursing Home Care.

    ERIC Educational Resources Information Center

    Braun, Kathryn L.; Rose, Charles L.

    1987-01-01

    Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…

  2. Novel ethical dilemmas arising in geriatric clinical practice.

    PubMed

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

    2015-05-01

    The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. PMID:25185872

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

    ERIC Educational Resources Information Center

    Bardach, Shoshana H.; Rowles, Graham D.

    2012-01-01

    Purpose: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution…

  4. E-Learning Virtual Patients for Geriatric Education

    ERIC Educational Resources Information Center

    Orton, Eric; Mulhausen, Paul

    2008-01-01

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

  5. Use of Readers Theater to Enhance Interdisciplinary Geriatric Education

    ERIC Educational Resources Information Center

    MacRae, Nancy; Pardue, Karen T.

    2007-01-01

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

  6. A Web-Based Framework for Improving Geriatric Education

    ERIC Educational Resources Information Center

    Hirth, Victor A.; Hajjar, Ihab

    2004-01-01

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

  7. Rasch Analysis of the Geriatric Depression Scale--Short Form

    ERIC Educational Resources Information Center

    Chiang, Karl S.; Green, Kathy E.; Cox, Enid O.

    2009-01-01

    Purpose: The purpose of this study was to examine scale dimensionality, reliability, invariance, targeting, continuity, cutoff scores, and diagnostic use of the Geriatric Depression Scale-Short Form (GDS-SF) over time with a sample of 177 English-speaking U.S. elders. Design and Methods: An item response theory, Rasch analysis, was conducted with…

  8. Attendance At Activities With a Geriatric Population: Antecedents and Consequences.

    ERIC Educational Resources Information Center

    Neff, Dennis B.

    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…

  9. Geriatric Knowledge and Educational Needs among Rural Health Care Professionals.

    ERIC Educational Resources Information Center

    Goins, R. Turner; Gainor, Sara Jane; Pollard, Cecil; Spencer, S. Melinda

    2003-01-01

    In a needs assessment of 84 rural health care professionals (44.1% physicians, 15.5% pharmacists, 14.3% nurses, 26.1% other), 39% considered their geriatrics knowledge above average. They were interested in learning more about Alzheimer's/dementia, medication use, and adverse effects. Preferred methods were videotapes, CD-ROM, and an…

  10. Vital links. Hospital's geriatric program integrates the spectrum of care.

    PubMed

    Holt, T

    1989-06-01

    In July 1988 St. Mary Medical Center (SMMC), Long Beach, CA, established Older Adult Services (OAS) to help the elderly of the community. At the time, SMMC was already providing a number of services for the elderly, but OAS enables it to provide a continuum of care. In addition, the medical staff committee developing the geriatric program recommended establishing a geriatric assessment team headed by a fellowship-trained geriatrician, having that geriatrician serve as medical director of the inpatient skilled nursing facility (SNF), having the geriatric team develop treatment protocols in various aspects of care, and extending OAS within the community. The categories of service within the continuum are extended care, acute care, ambulatory care, home care, outreach, wellness, and housing. SMMC does not directly provide all services; rather, through integrating mechanisms, it uses community-based services or services provided by other institutions to meet some patient needs. A key element to integrating the continuum is the involvement of OAS in the SNF. The SNF medical director can bring the expertise of the geriatric assessment team to a wide sphere of the medical community. This sphere of influence quickly spreads to the hospital's entire medical community. Through direct participation in utilization review and quality assurance in the SNF, the OAS director can influence the quality of care. PMID:10293329

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

    ERIC Educational Resources Information Center

    Levkoff, Sue; And Others

    1996-01-01

    Describes 10 modules for primary care practitioners on health promotion/disease prevention for the elderly on these topics: Alzheimer's disease in minorities, dehydration, diabetes, elder abuse, geriatric nutrition, oncology, oral health in long-term care, incontinence, injury prevention, and physical activity. These areas are significant for…

  12. Geriatric Training Needs of Nursing-Home Physicians

    ERIC Educational Resources Information Center

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

    2009-01-01

    Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

  13. Comprehensive geriatric assessment basics for the cancer professional.

    PubMed

    Extermann, Martine

    2003-01-01

    A comprehensive geriatric assessment (CGA) has been a cornerstone of geriatric practice for many years. However, oncology practitioners are still unfamiliar with it. Yet, recent research has shown an important potential to improve the daily care of older cancer patients. The purpose of this article is to review the basic nature of a CGA, its effectiveness, its applicability to cancer patients, and its cost-effectiveness. Cancer is one of the major health problems in our society. Furthermore, the incidence of cancer increases with age. Nowadays, half of the cancers occur beyond the age of 70. Given the aging of the US population, this proportion is expected to increase in the next decades. A challenge for the oncologists is that older people can have a highly variable health status. Yet little is known yet about how to best assess and integrate into decision making the various health problems patients may have. Taking their clues from the experience of geriatricians, geriatric oncologists advocate the use of a comprehensive geriatric assessment (CGA) as one of the tools to deal with this problem. It is, for example, part of the National Comprehensive Cancer Network (NCCN) guidelines for the elderly'. This article offers a primer on CGA for the reader unfamiliar with the approach in an oncologic setting. PMID:12699111

  14. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries

    PubMed Central

    Bajwa, Sukhminder Jit Singh

    2015-01-01

    Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population. PMID:25810963

  15. Integrating Geriatric Dentistry into General Practice Residency Programs.

    ERIC Educational Resources Information Center

    Lloyd, Patrick M.; Shay, Kenneth

    1989-01-01

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

  16. The Termination Phase in Group Therapy: Implications for Geriatric Groups.

    ERIC Educational Resources Information Center

    Eklof, Mona

    1984-01-01

    Hypothesizes that a geriatric counseling group would have a particularly difficult time with termination because of their unique position in relation to the issues of loss and dependency. Concludes that the major work of group therapy termination involves the issues of loss and separation anxiety. (LLL)

  17. The Differential Impact of Clerk Interest and Participation in a Child and Adolescent Psychiatry Clerkship Rotation upon Psychiatry and Pediatrics Residency Matches

    ERIC Educational Resources Information Center

    Hanson, Mark D.; Szatmari, Peter; Eva, Kevin W.

    2011-01-01

    Objective: The authors evaluated the differential impact of clerk interest and participation in a Child and Adolescent Psychiatry (CAP) clerkship rotation upon psychiatry and pediatrics residency matches. Method: Authors studied clerks from the McMaster University M.D. program graduating years of 2005-2007. Participants were categorized as 1)…

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

    PubMed Central

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

    2014-01-01

    Purpose: This study was aimed to design Objective Structured Field Examination (OSFE) and also standardize the course plan of community pharmacy clerkship at Pharmacy Faculty of Tabriz University of Medical Sciences (Iran). Methods: The study was composed of several stages including; evaluation of the old program, standardization and implementation of the new course plan, design and implementation of OSFE, and finally results evaluation. Results: Lack of a fair final assessment protocol and proper organized educating system in various fields of community pharmacy clerkship skills were assigned as the main weaknesses of the old program. Educational priorities were determined and student’s feedback was assessed to design the new curriculum consisting of sessions to fulfill a 60-hour training course. More than 70% of the students were satisfied and successfulness and efficiency of the new clerkship program was significantly greater than the old program (P<0.05). In addition, they believed that OSFE was a suitable testing method. Conclusion: The defined course plan was successfully improved different skills of the students and OSFE was concluded as a proper performance based assessment method. This is easily adoptable by pharmacy faculties to improve the educational outcomes of the clerkship course. PMID:24511477

  19. Nuclear Medicine

    MedlinePlus

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

  20. Integrating Structured Learning and Scholarly Activities into Clerkship Rotations: A Win–Win for Students and Preceptors

    PubMed Central

    Miller, Stephannie; Fulton, Judith; Mostow, Eliot

    2014-01-01

    Objective: To merge scholarly activity into the curriculum developed for medical students electing a rotation in wound care and/or dermatology. Approach: The authors adapted the unique wound care curriculum developed for medical student rotators and residents to incorporate structured scholarly projects, opportunities for mentorship, and feedback for continued improvement. Results: Benefits have been observed to both students and to the clinic, as reflected by online survey results, increased productivity in the form of posters and manuscripts, and opportunities for professional networking. Discussion: Rotations and clerkships can be transformed from haphazard, bystander observational experiences to active participation that enhances comprehension and retention, while also providing benefits to preceptors. Innovation: Integration between research, education, and clinical activities in a structured way can provide opportunity for enhanced learning experiences and promote the concept of evidence-based practice. Conclusion: With observed benefits to students, researchers, and staff in this clinical setting, other clerkship rotation settings should consider an integrated and structured approach to learning, which includes scholarly activities. Further rigorous program evaluation is necessary to further quantify preliminary positive feedback regarding this approach. PMID:24804160

  1. Integrating Structured Learning and Scholarly Activities into Clerkship Rotations: A Win-Win for Students and Preceptors.

    PubMed

    Miller, Stephannie; Fulton, Judith; Mostow, Eliot

    2014-05-01

    Objective: To merge scholarly activity into the curriculum developed for medical students electing a rotation in wound care and/or dermatology. Approach: The authors adapted the unique wound care curriculum developed for medical student rotators and residents to incorporate structured scholarly projects, opportunities for mentorship, and feedback for continued improvement. Results: Benefits have been observed to both students and to the clinic, as reflected by online survey results, increased productivity in the form of posters and manuscripts, and opportunities for professional networking. Discussion: Rotations and clerkships can be transformed from haphazard, bystander observational experiences to active participation that enhances comprehension and retention, while also providing benefits to preceptors. Innovation: Integration between research, education, and clinical activities in a structured way can provide opportunity for enhanced learning experiences and promote the concept of evidence-based practice. Conclusion: With observed benefits to students, researchers, and staff in this clinical setting, other clerkship rotation settings should consider an integrated and structured approach to learning, which includes scholarly activities. Further rigorous program evaluation is necessary to further quantify preliminary positive feedback regarding this approach. PMID:24804160

  2. Use of Geriatric Assessment for Older Adults in the Oncology Setting: A Systematic Review

    PubMed Central

    2012-01-01

    Background Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult’s medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). Methods We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. Results We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10–45min. Geriatric assessment was most often completed to describe a patient’s health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%–50% of treatment decisions. Conclusion Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment

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

    PubMed Central

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

    2015-01-01

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

  4. Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture

    PubMed Central

    Jain, Deepak; Sidhu, Guraziz Singh; Mears, Simon C.; Yamin, Mohammad; Mahindra, Pankaj; Pannu, Harminder Singh

    2015-01-01

    Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n = 42) and diabetes mellitus (n = 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n = 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n = 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality. PMID:26246953

  5. Isolation followed by integration: a model for development of a separate geriatric course.

    PubMed

    Wallace, Meredith; Lange, Jean; Grossman, Sheila

    2005-06-01

    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

  6. Integrating and Evaluating Geriatrics in Medical School: A Novel Approach for the Challenge

    ERIC Educational Resources Information Center

    Besdine, Richard W.; Shield, Renee R.; McNicoll, Lynn; Campbell, Susan E.; Wetle, Terrie

    2011-01-01

    Brown Medical School developed a comprehensive curriculum in which enriched aging content increased from 22 to 80 hours in preclerkship courses and was also added for clerkships, residencies, and nongeriatrician physicians. Innovative evaluation strategies are also described. Highlights include "treasure hunts" in the anatomy laboratory, a…

  7. Are Gold Standard Depression Measures Appropriate for Use in Geriatric Cancer Patients? A Systematic Evaluation of Self-Report Depression Instruments Used With Geriatric, Cancer, and Geriatric Cancer Samples

    PubMed Central

    Nelson, Christian J.; Cho, Christina; Berk, Alexandra R.; Holland, Jimmie; Roth, Andrew J.

    2010-01-01

    Purpose Geriatric issues in cancer are becoming prominent. Depression is a significant concern for both the elderly and patients with cancer, yet identifying depression in these patients is difficult and often leads to under-recognition. We conducted a systematic review to determine which depression instruments are appropriate for use in geriatric patients with cancer. Methods We identified the most commonly used self-report depression instruments. We then used the criteria established in the US Food and Drug Administration Draft Guidance on Patient-Reported Outcome Measures to determine the extent of validation evidence of these measures in geriatric cancer populations. Finally, we determined which instruments captured depressive symptoms that are common among elderly patients with cancer. Results Eight measures were selected as the most commonly used instruments. These were the Beck Depression Inventory-II, Brief Symptom Inventory-18, Center for Epidemiologic Studies–Depression Scale, Geriatric Depression Scale-15, Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Profile of Mood States–Short Form, and Zung Self-Rating Depression Scale. Many have been validated for use with geriatric adults and patients with cancer; however, data addressing content validity and responder definition were lacking. To date, there is no validation information for geriatric patients with cancer. Furthermore, symptom profile analysis revealed that these measures do not identify many symptoms signaling depression in geriatric patients with cancer. Conclusion The validation evidence for use of common depression instruments in geriatric patients with cancer is lacking. This, and the possibility that these measures may not assess common depressive symptoms in geriatric patients with cancer, questions the adequacy of these scales in this population. PMID:19996030

  8. Geriatric Rehabilitation Patients’ Perceptions of Unit Dining Locations

    PubMed Central

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

    2014-01-01

    Background Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients’ perceptions regarding meals in a common dining area versus at the bedside. Methods An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Results Eating location was influenced by compliance with the perceived rules of the unit, physical and emotional well-being, and quarantine orders. Certain participants preferred eating in the common dining room where they had more assistance from hospital staff, a more attractive physical environment, and the opportunity to socialize. However, other participants preferred eating at their bedsides, feeling the quality of social interaction was poor in the dining room. Conclusions Participants’ experiences of, and preferences for, communal dining differed. If the benefits of communal dining are to be maximized, different experiences of this practice must be considered. PMID:24883161

  9. Challenges in the pharmacological treatment of geriatric asthma.

    PubMed

    Agusta, Fabio; Battaglia, Salvatore; Benfante, Alida; Spatafora, Mario; Scichilone, Nicola

    2016-07-01

    Asthma in older populations is characterized by frequent comorbid conditions, which increase the risk of side effects and of detrimental interactions between respiratory and non-respiratory drugs. These observations lead to the need to manage asthma in older populations by applying a multidimensional assessment and a multidisciplinary treatment; therefore, we favor the use of the 'geriatric' term to define asthma in the elderly. Geriatric asthma is a complex disease, which may not necessarily imply that it is also complicated, although the two conditions may often coexist. On this basis, the switch from an organ-driven management to the holistic approach may be the key factor to attain optimal control of the disease in this age range. The current review discusses the age-related factors affecting asthma treatment in the oldest individuals, such as the comorbid conditions, and age-related changes of metabolism and excretion that can impair the efficacy and safety of drugs. PMID:26986042

  10. [Geriatric fracture centers. Improved patient care and economic benefits].

    PubMed

    Kates, S L

    2016-01-01

    The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. It is due to these factors that the concept of an elderly trauma center was developed. These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients. PMID:26658903

  11. E-learning virtual patients for geriatric education.

    PubMed

    Orton, Eric; Mulhausen, Paul

    2008-01-01

    Computer-based virtual patients (VPs) are an emerging medium for medical education that addresses barriers faced by geriatrics educators. Research has shown VPs to be as effective in changing knowledge and behavior as more traditional forms of teaching. This paper presents a descriptive study of the development of the University of Iowa's GeriaSims VP programs and their effectiveness as tools for geriatric education. More than 85% of the responses to an evaluation survey of GeriaSims users indicated favorable perceptions of instructional effectiveness, efficiency, and ease of use. GeriaSims VP programs were used effectively by multiple levels of learners and provide flexibility to these learners in scheduling their learning. PMID:18215989

  12. Cutaneous oncologic and cosmetic surgery in geriatric patients.

    PubMed

    Scheinfeld, Noah; Yu, Thomas; Weinberg, Jeffrey; Gordon, Marsha; Silapunt, Sirunya; Norman, Robert A; Alam, Murad

    2004-01-01

    A wide array of surgical procedures is available to geriatric patients. These interventions can enhance the appearance of patients and facilitate the removal of skin cancers. Pre-existing medical conditions of geriatric patients must be considered comprehensively when selecting and performing cutaneous surgical procedures. Many older patients suffer from a variety of diseases and take a variety of medications and herbal supplements to ameliorate the consequences of such diseases. In general, skin surgery can be performed safely on even very old patients, provided precautions are followed. The biopsychosocial well-being and essence of patients must also be addressed when performing dermatologic surgery. If patients are treated holistically and comprehensively, their surgical experience can be enhanced and their health and appearance improved. PMID:15018014

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

    PubMed

    Synofzik, M; Maetzler, W

    2015-04-01

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

  14. New lessons of nurturing life for geriatric patients.

    PubMed

    Butler, James P; Fujii, Masahiko; Sasaki, Hidetada

    2012-01-01

    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

  15. The frailty syndrome: a critical issue in geriatric oncology.

    PubMed

    Ferrucci, Luigi; Guralnik, Jack M; Cavazzini, Chiara; Bandinelli, Stefania; Lauretani, Fulvio; Bartali, Benedetta; Repetto, Lazzaro; Longo, Dan L

    2003-05-01

    Evidence exists that the geriatric intervention guided by Comprehensive Geriatric Assessment (CGA) has positive effects on a number of important health outcomes in frail older patients. Although a number of observational studies, editorials, special articles and clinical reports, suggest that CGA should be used to guide the assessment and clinical decision-making in older cancer patients, there is limited support to this view in the literature. Older patients that are diagnosed with cancer are usually healthier and less problematic than persons of the same age who are randomly sampled from the general population. In these persons, the cancer dominates the clinical picture and, therefore, instruments especially tuned for the frail elderly may provide little information. The concept of the frailty syndrome, characterized by high susceptibility, low functional reserve and unstable homeostasis, has recently received a lot of attention by the geriatric community. A CGA approach, which also evaluates elements of the frailty syndrome, may be of great interest for those oncologists who want to identify older patients likely to develop severe toxicity and severe side effects in response to aggressive treatment. Improvements in the definition of the frailty syndrome may profit from the clinical experience of oncologists. PMID:12711358

  16. Venlafaxine-Induced Orthostatic Hypotension in a Geriatric Patient

    PubMed Central

    Chikkaramanjegowda, Vidyashree; de Leon, Jose

    2013-01-01

    Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day) but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses. PMID:23984153

  17. Diabetes Medicines

    MedlinePlus

    ... Financial Help for Diabetes Care Diabetes Statistics Diabetes Medicines What do diabetes medicines do? Over time, high levels of blood glucose, ... your diabetes medicines, food choices, and physical activity. Medicines for My Diabetes Ask your doctor what type ...

  18. [Undergraduate education of laboratory medicine in Hirosaki University School of Medicine].

    PubMed

    Shoji, Masaru; Yasujima, Minoru

    2003-11-01

    The Department of Laboratory Medicine is responsible for the several undergraduate educational programs in Hirosaki University School of Medicine. We describe here how these programs are taken place. The staffs of the department participate in premedical lectures for the first grade students under the name of "21st century education" to introduce the medical english, human science, health and disease. As an early clinical exposure, the first grade medical students spend half day to make rotational visit to major clinical departments in the University Hospital once a week. We show them how each section of the Department of Clinical Laboratory works. At Year 4 during preclinical courses, 15 credit lectures of laboratory medicine based on clinical core are provided by our staffs and invited lecturers. Year 4 students can also choose one of elective research courses. This year, 5 students studied three topics of diagnostic testing and derivative research in the setting of an academic clinical laboratory. The core clerkship in laboratory medicine includes the necessary skills for acquiring a blood sampling and performing core laboratory examination. Emphasis is placed on interpretation of the data as well as the sampling and examination. We have played some role in the introduction of tutorial learning methods into preclinical courses in the year of 2003. Although we need supply of directors manpower, we hope that all of the students can acquire quality of the generally permissive six year of medical school and prepare postgraduate educational programs through our education courses. PMID:14679792

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Melaku, Tadesse; Srikanth, Akshaya; Getaye, Yonas; Admasu, Sewunet; Alkalmi, Ramadan

    2016-01-01

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

  2. Student Senior Partnership Program: University of California Irvine School of Medicine

    ERIC Educational Resources Information Center

    Fitzpatrick, Camille; Musser, Anne; Mosqueda, Laura; Boker, John; Prislin, Michael

    2006-01-01

    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,…

  3. No longer waiting for an accident to happen: Simulation in emergency medicine.

    PubMed

    Ellison, Stefanie; Sullivan, Christine; McCullough, Robert

    2013-01-01

    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

  4. How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes toward Geriatric Care

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.

    2009-01-01

    Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the…

  5. 77 FR 49865 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-17

    ...), Veterans Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent... of Veterans Affairs and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities and programs to meet...

  6. Strengthening Geriatric Knowledge and Use of Interdisciplinary Teams among Allied Health Students and Practitioners.

    ERIC Educational Resources Information Center

    Schrader, Susan L.; Blue, Rebecca; Miller, Doreen; Jensen, Gwenneth; Zawada, Edward T., Jr.; Hill, Paula; Johannsen, Gail; Elsberry, Dorothy Anne; Nelson, Debralee; Lockwood, Dean

    1999-01-01

    In a three-year collaborative venture between a hospital and a university, an interdisciplinary team trained 684 allied health professionals and students in geriatrics. Outcomes included increased geriatric knowledge, more graduates serving rural underserved areas, and more interdisciplinary clinical initiatives. (SK)

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

    PubMed

    Natali, Jean-Philippe; Schwald, Nathalie; Bach, Frédérique; Bourgouin, Gaëlle; Chiffray, Dominique; Bloch, Frédéric

    2015-01-01

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

  8. Mortality of Geriatric and Younger Patients with Schizophrenia in the Community

    ERIC Educational Resources Information Center

    Ran, Mao-Sheng; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Li, Li; Li, Si-Gan; Mao, Wen-Jun; Hu, Shi-Hui; Schwab, Gerhard; Conwell, Yeates

    2008-01-01

    Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age greater than or equal to 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a…

  9. Geriatric Expertise among Medical School Faculty: Preparing for the Challenges of an Aging Population

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Jenkins, Carol L.; Eleazer, G. Paul; Kelsey, Susan G.

    2007-01-01

    This study examined non-geriatrician physicians' experiences in a geriatrics-focused faculty development program, and effects of the program on their geriatrics knowledge and their teaching and practice. In-depth interviews were conducted with all physicians (n = 26) participating in the Dean's Faculty Scholars in Aging program. Most participants…

  10. The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

    ERIC Educational Resources Information Center

    Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

  11. Cognitive Deficits in Geriatric Depression: Clinical Correlates and Implications for Current and Future Treatment

    PubMed Central

    Morimoto, Sarah Shizuko; Alexopoulos, George S.

    2013-01-01

    Synopsis The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression, and describe their clinical significance. We then summarize the complex relationship between geriatric depression and dementia and discuss possible shared mechanisms. Last, we present evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation. PMID:24229654

  12. Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

    ERIC Educational Resources Information Center

    Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea

    2012-01-01

    The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  14. 76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee...

  15. 75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet the... discussions on VA's geriatrics and extended care programs, aging research activities, update on VA's...

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

    ERIC Educational Resources Information Center

    Martinez, Iveris L.; Mora, Jorge Camilo

    2012-01-01

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

  17. An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

    ERIC Educational Resources Information Center

    Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping

    2013-01-01

    A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized…

  18. Impairment in Instrumental Activities of Daily Living and the Geriatric Syndrome of Self-Neglect

    ERIC Educational Resources Information Center

    Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.

    2008-01-01

    Purpose: We sought to characterize self-neglect definitively as a geriatric syndrome by identifying an association with functional impairment. Design and Methods: We performed a cross-sectional home evaluation of 100 community-living older adults referred by Adult Protective Services for geriatric self-neglect and 100 matched adults from a…

  19. [Geriatric rehabilitation from the perspective of Book 9 of the German social code, SGB IX].

    PubMed

    Fuchs, H

    2007-10-01

    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

  20. California Geriatric Education Center Logic Model: An Evaluation and Communication Tool

    ERIC Educational Resources Information Center

    Price, Rachel M.; Alkema, Gretchen E.; Frank, Janet C.

    2009-01-01

    A logic model is a communications tool that graphically represents a program's resources, activities, priority target audiences for change, and the anticipated outcomes. This article describes the logic model development process undertaken by the California Geriatric Education Center in spring 2008. The CGEC is one of 48 Geriatric Education…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  2. 77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee...

  3. An Outcome Evaluation of Reality Orientation Therapy with Geriatric Patients in a State Mental Hospital

    ERIC Educational Resources Information Center

    Harris, Clarke S.; Ivory, Peter B. C. B.

    1976-01-01

    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)

  4. Community Psychiatrists Who See Geriatric Patients: What's Training Got to Do with It?

    ERIC Educational Resources Information Center

    Lieff, Susan; Andrew, Melissa; Tiberius, Richard

    2004-01-01

    Objective: This study examines the issues influencing psychiatrists' decisions to provide care to the under-served geriatric population. Methods: Community-based psychiatrists who see geriatric patients participated in focus group discussions exploring factors that influence the characteristics of their current practices. Results: Personal themes,…

  5. Assessment of the geriatric competence and perceived needs of Italian nephrologists: an internet survey.

    PubMed

    Aucella, Filippo; Brunori, Giuliano; Dalmartello, Michela; Leosco, Dario; Paolisso, Giuseppe; Marangella, Martino; Capasso, Giovanni Battista; Antonelli Incalzi, Raffaele

    2016-06-01

    An internet survey was set up to assess the geriatric competence and perceived needs of 337 members of the Italian society of nephrology (SIN). The survey assessed how well aware nephrologists are of the typical geriatric conditions and needs of their elderly chronic kidney disease (CKD) patients. SIN associates were also questioned about their current use of comprehensive geriatric assessment, prescription of potentially nephrotoxic drugs, and screening for osteoporosis. The main finding is that CKD and dialysis are almost unanimously perceived as typically geriatric conditions, but knowledge and use of geriatric tools are scanty. While use of potentially inappropriate drugs is rare, almost half of the patients are not screened for osteoporosis. The significant clinical gaps observed could greatly impair the management of older CKD patients, and call for an urgent educational intervention. PMID:26385799

  6. Structures and geriatrics from a failure analysis experience viewpoint

    SciTech Connect

    Hopper, D.M. )

    1993-05-01

    In a failure analysis consulting engineering practice one sees a variety of structural failures from which observations may be made concerning geriatric structures. Representative experience with power plants, refineries, offshore structures, and forensic investigations is summarized and generic observations are made regarding the maintenance of fitness for purpose of structures. Although it is important to optimize the engineering design for a range of operational and environmental variables, it is essential that fabrication and inspection controls exist along with common sense based ongoing monitoring and operations procedures. 18 figs.

  7. Health care: economic impact of caring for geriatric patients.

    PubMed

    Rich, Preston B; Adams, Sasha D

    2015-02-01

    National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. PMID:25459539

  8. Psychosocial work load and stress in the geriatric care

    PubMed Central

    2010-01-01

    Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database). Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration). Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the

  9. [Geriatric patients with chronic kidney insufficiency: which antalgia?].

    PubMed

    Ionescu, M; Hemett, O M; Descombes, E; Blondel, N; Hayoz, D

    2014-04-01

    Pain is a leading cause of office visits. In the geriatric population, it is known that the prevalence of renal failure increases exponentially with age, modifing the elimination of drugs and of their metabolites. What analgesia should be offered to these patients? The holy grail would be a medication without renal elimination, without toxic metabolites and without nephrotoxicity. Based on the literature we try to propose a specific approach to analgesia in older patients with kidney insufficiency, in order to help practitioners to better prescribe for this group of patients. PMID:24791426

  10. Absence of Streptococcus pneumoniae in pharyngeal swabs of geriatric inpatients.

    PubMed

    Jomrich, Nina; Kellner, Silvia; Djukic, Marija; Eiffert, Helmut; Nau, Roland

    2015-07-01

    Colonization of the pharynx by Streptococcus pneumoniae was studied in 185 in-hospital geriatric patients (median age 81 years) from 29 March 2011 to 22 June 2011. Swabs were plated on blood agar plates. Colonies with a morphology suggesting S. pneumoniae were further analyzed. Surprisingly, pneumococci were not found in any of the samples. Pneumococci chronically colonizing the pharynx of elderly people may be much rarer than previously thought and probably are not the source of pneumococcal pneumonia in old age. PMID:25746605

  11. The geriatric management of frailty as paradigm of "The end of the disease era".

    PubMed

    Cesari, Matteo; Marzetti, Emanuele; Thiem, Ulrich; Pérez-Zepeda, Mario Ulises; Abellan Van Kan, Gabor; Landi, Francesco; Petrovic, Mirko; Cherubini, Antonio; Bernabei, Roberto

    2016-06-01

    The sustainability of healthcare systems worldwide is threatened by the absolute and relative increase in the number of older persons. The traditional models of care (largely based on a disease-centered approach) are inadequate for a clinical world dominated by older individuals with multiple (chronic) comorbidities and mutually interacting syndromes. There is the need to shift the center of the medical intervention from the disease to the biological age of the individual. Thus, multiple medical specialties have started looking with some interest at concepts of geriatric medicine in order to better face the increased complexity (due to age-related conditions) of their average patient. In this scenario, special interest has been given to frailty, a condition characterized by the reduction of the individual's homeostatic reserves and increased vulnerability to stressors. Frailty may indeed represent the fulcrum to lever for reshaping the healthcare systems in order to make them more responsive to new clinical needs. However, the dissemination of the frailty concept across medical specialties requires a parallel and careful consideration around the currently undervalued role of geriatricians in our daily practice. PMID:26997416

  12. Looking forward in geriatric anxiety and depression: implications of basic science for the future.

    PubMed

    Gershenfeld, Howard K; Philibert, Robert A; Boehm, Gary W

    2005-12-01

    Major depression and anxiety are common psychiatric illnesses whose etiology remains incompletely understood. This review highlights progress in understanding the etiology of these illnesses through genetic strategies and looks forward to their impact on geriatric psychiatry. We briefly address three broad domains of progress, namely 1) genetic approaches to etiology, including linkage and association studies, pharmacogenetics ("personalized medicine"), and gene x environment interactions; 2) mechanisms of thyroid and testosterone action via nuclear receptors, given these hormones' status as possible augmenters of antidepressants; and 3) the role of the neuroimmune system as a contributor to the stress response. Genetic strategies offer one path for converting correlational findings into causal pathways while complementing studies of a gene's function at the molecular, cellular, network, and whole-organismal levels. Neuroendocrine supplementation (thyroid and testosterone) has a long history and tradition. A molecular understanding of nuclear receptor pathways and their coactivators, the mediator complex proteins, provides a rationale for improved targeting of hormonal action in a tissue-selective manner, yielding drugs with improved safety and efficacy. Neural-immune interactions in psychiatric illness remain tantalizing topics. Research suggests that cytokine pathways may contribute to the maintenance or susceptibility to stress, anxiety, and depressive disorders. The reciprocal and recursive interactions among basic science, drug discovery, and clinical science will continue to provide hopeful themes for improving the lives of patients with treatment-refractive psychiatric illness. PMID:16319295

  13. Diabetes Medicines

    MedlinePlus

    ... choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends on your type of diabetes, ... pills. Combination pills contain two kinds of diabetes medicine in one tablet. Some people take pills and ...

  14. Nuclear Medicine.

    ERIC Educational Resources Information Center

    Badawi, Ramsey D.

    2001-01-01

    Describes the use of nuclear medicine techniques in diagnosis and therapy. Describes instrumentation in diagnostic nuclear medicine and predicts future trends in nuclear medicine imaging technology. (Author/MM)

  15. Aerospace Medicine

    NASA Technical Reports Server (NTRS)

    Michaud, Vince

    2015-01-01

    NASA Aerospace Medicine overview - Aerospace Medicine is that specialty area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space.

  16. Estimating Geriatric Mortality after Injury Using Age, Injury Severity, and Performance of a Transfusion: The Geriatric Trauma Outcome Score

    PubMed Central

    Zhao, Frank Z.; Wolf, Steven E.; Nakonezny, Paul A.; Minhajuddin, Abu; Rhodes, Ramona L.; Paulk, M. Elizabeth

    2015-01-01

    Abstract Background: A tool to determine the probability of mortality for severely injured geriatric patients is needed. Objective: We sought to create an easily calculated geriatric trauma prognostic score based on parameters available at the bedside to aid in mortality probability determination. Methods: All patients ≥65 years of age were identified from our Level I trauma center's registry between January 1, 2000 and December 31, 2013. Measurements included age, Injury Severity score (ISS), units of packed red blood cells (PRBCs) transfused in the first 24 hours, and patients' mortality status at the end of their index hospitalization. As a first step, a logistic regression model with maximum likelihood estimation and robust standard errors was used to estimate the odds of mortality from age, ISS, and PRBCs after dichotomizing PRBCs as yes/no. We then constructed a Geriatric Trauma Outcome (GTO) score that became the sole predictor in the re-specified logistic regression model. Results: The sample (n=3841) mean age was 76.5±8.1 years and the mean ISS was 12.4±9.8. In-hospital mortality was 10.8%, and 11.9% received a transfusion by 24 hours. Based on the logistic regression model, the equation with the highest discriminatory ability to estimate probability of mortality was GTO Score=age+(2.5×ISS)+22 (if given PRBCs). The area under the receiver operating characteristic curve (AUC) for this model was 0.82. Selected GTO scores and their related probability of dying were: 205=75%, 233=90%, 252=95%, 310=99%. The range of GTO scores was 67.5 (survivor) to 275.1 (died). Conclusion: The GTO model accurately estimates the probability of dying, and can be calculated at bedside by those possessing a working knowledge of ISS calculation. PMID:25974408

  17. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement: American Geriatrics Society Ethics Committee.

    PubMed

    2015-03-01

    There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high-quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need. PMID:25803784

  18. "Pedogeriatrics": a pediatric nephrologist's outlook on common challenges facing pediatric and geriatric nephrologists.

    PubMed

    Grünberg, Jose

    2010-03-01

    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

  19. Integrating behavior change theory into geriatric case management practice.

    PubMed

    Enguidanos, S

    2001-01-01

    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, focusing on maintaining health status and improving linkages with medical and community resources. Studies testing the effectiveness of these models have failed to demonstrate their effectiveness in reducing depression, reducing acute care service use, and improving or maintaining health status. The Geriatric Case Management models presented in these lack an evidence-based, theoretical framework that provides definition and direction for case management practice. This article introduces behavior change theories as a method of structuring and delineating the case management intervention. The Transtheoretical Model and the Theory of Planned Behavior are discussed and methods of integrating these theories into practice are discussed. PMID:11878076

  20. Clinical preference for factors in treatment of geriatric depression

    PubMed Central

    Riepe, Matthias W

    2015-01-01

    Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. PMID:25565848

  1. Incontinence-associated dermatitis and pressure ulcers in geriatric patients.

    PubMed

    Kottner, J; Beeckman, D

    2015-12-01

    The key characteristics of geriatric patients are advanced age, multimorbidity, a decrease of psychical performance and care dependency. In addition, advanced age, chronic and acute diseases and treatments (e.g. polypharmacy) lead, either directly or indirectly, to a wide range of skin and tissue problems. Incontinence-associated dermatitis and pressure ulcers (PUs) belong to the most prevalent in geriatric settings. Prolonged exposure of the skin to urine and/or stool can cause an irritant contact dermatitis. Skin surface 'wetness', increased skin surface pH, digestive intestinal enzymes, repeated skin cleansing activities, and a possible occlusive environment contribute to irritation and inflammation. Prevention and treatment includes activities to maintain and to enhance continence and to limit, to reduce exposure of the skin to urine and stool, and to promote healing and reepithelialisation. In frail aged skin, it is recommended to use incontinence products with smooth and breathable materials with maximum absorption capacity. Immediate skin cleansing after soiling using mild cleansers and protective and caring leave-on products are recommended. PUs are localized injuries to the skin and/or underlying tissue caused by sustained deformations of skin and underlying soft tissues. PUs management includes risk assessment, repositioning and mobilization, and the use of appropriate support surfaces. Patients must be never positioned directly on an existing PU. Especially at end of life, the PU closure and wound healing may not be the primary therapeutic goal. PMID:26186379

  2. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    PubMed Central

    Ellis, Kristen; Rubal-Peace, Georgina; Chang, Victoria; Liang, Eva; Wong, Nicolas; Campbell, Stephanie

    2016-01-01

    Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit. PMID:27025523

  3. [Geriatric nursing staff retention. Opportunities, potentials, and strategies].

    PubMed

    Joost, A

    2013-08-01

    Retaining geriatric nurses in their line of work could be an important strategy to prevent the shortage of skilled staff in the future. A prerequisite for this is detailed knowledge of the length and structure of professional careers. The IWAK ( Institut für Wirtschaft, Arbeit und Kultur) evaluated data from the German Social Insurance and carried out a structural analysis of the professional careers of geriatric nurses. Results showed that the average duration of professional careers is 20 years, of which 11.7 years constitute the period of employment and 7.8 years account for periods of inactivity. According to these findings, there is a considerable potential in extending professional careers and reducing the periods of inactivity to make better use of the existing skilled staff and to reduce staff shortage in this area. Concrete measures could involve improvement of working conditions (with the aim of avoiding long periods of inactivity and illness-related premature career endings as well as of increasing job satisfaction), creating better conditions for a good balance between work and family life, as well as setting up individual strategies to expand weekly working hours. Key players are businesses but also local authorities and politicians. PMID:23884527

  4. Chronic diseases in captive geriatric female Chimpanzees (Pan troglodytes).

    PubMed

    Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L

    2012-04-01

    The current aging population of captive chimpanzees is expected to develop age-related diseases and present new challenges to providing their veterinary care. Spontaneous heart disease and sudden cardiac death are the main causes of death in chimpanzees (especially of male animals), but little is known about the relative frequency of other chronic diseases. Furthermore, female chimpanzees appear to outlive the males and scant literature addresses clinical conditions that affect female chimpanzees. Here we characterize the types and prevalence of chronic disease seen in geriatric (older than 35 y) female chimpanzees in the colony at Alamogordo Primate Facility. Of the 16 female chimpanzees that fit the age category, 87.5% had some form of chronic age-related disease. Cardiovascular-related disease was the most common (81.25%) followed by metabolic syndrome (43.75%) and renal disease (31.25%). These data show the incidence of disease in geriatric female chimpanzees and predict likely medical management challenges associated with maintaining an aging chimpanzee population. PMID:22546920

  5. Potential drug interactions in an ambulatory geriatric population.

    PubMed

    Costa, A J

    1991-09-01

    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

  6. Poor oral health, a potential new geriatric syndrome.

    PubMed

    van der Putten, Gert-Jan; de Baat, Cees; De Visschere, Luc; Schols, Jos

    2014-02-01

    This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome. PMID:24446975

  7. Oral Examination: A Model for Its Use within a Clinical Clerkship.

    ERIC Educational Resources Information Center

    Vu, Nu V.; And Others

    1981-01-01

    The Department of Obstetrics and Gynecology at the Southern Illinois University School of Medicine has devised an evaluation system that not only provides the advantages of oral examination but also attempts to alleviate some of its disadvantages. The system uses oral examination to assess students' content knowledge. (MLW)

  8. A Structured Curriculum for an Undergraduate Elective Clerkship in Pediatric Nephrology

    ERIC Educational Resources Information Center

    Rauch, Jerome S.; Schwartz, M. William

    1977-01-01

    An organizational structure was developed at the University of Pennsylvania School of Medicine for a pediatric nephrology elective. A study guide and format ensure that students have a common knowledge base--the lack of which has been a problem in electives--and allows them to participate in patient problems. (LBH)

  9. A Comparison of Several Outcome Measures Used to Evaluate a Psychiatric Clerkship.

    ERIC Educational Resources Information Center

    Cuerdon, Timothy; And Others

    The teaching of interviewing skills is increasingly incorporated into clinical medicine courses in American medical schools, yet the attempts to evaluate the effectiveness of these efforts have been woefully inadequate. Typical outcome measures have included paper and pencil tests of knowledge, preceptor evaluations of clinical performance, and…

  10. Geriatric Small Bowel Obstruction: An Analysis of Treatment and Outcomes Compared to a Younger Cohort

    PubMed Central

    Krause, William R.; Webb, Travis P.

    2016-01-01

    Background Small bowel obstruction (SBO) is a common condition, but little is known about its presentation, management, and outcomes in geriatric patients. Methods A retrospective review was performed comparing geriatric (≥65 years of age) and non-geriatric patients admitted with SBO. Admission characteristics, treatment, and outcomes were compared. Data analysis included Student’s t test and chi-square test or Fisher exact test. Results Among 80 geriatric and 136 non-geriatric patients no difference was observed between admission characteristics, treatment, time to or type of surgery, length of post-op stay, or overall complications. Cardiac complications (15% vs 0%, p=0.0082) and sub-acute care facility discharge (29% vs 5%, p<0.001) were more common for geriatric patients. Conclusions Compared to younger adults, elderly patients with SBO have similar presentations and overall outcomes with the exception of cardiac morbidity and discharge disposition. Pre-operative attention to cardiac risk profile and discharge disposition discussion should be encouraged. Summary This study analyzes geriatric patients presenting with small bowel obstruction when cared for by an Acute Care Surgery service. Compared to younger adults, the presentation, treatment response, and outcomes are similar with the exception of cardiac complications and discharge destination. PMID:25048569

  11. Geriatric Trauma: A Radiologist's Guide to Imaging Trauma Patients Aged 65 Years and Older.

    PubMed

    Sadro, Claudia T; Sandstrom, Claire K; Verma, Nupur; Gunn, Martin L

    2015-01-01

    Radiologists play an important role in evaluation of geriatric trauma patients. Geriatric patients have injury patterns that differ markedly from those seen in younger adults and are susceptible to serious injury from minor trauma. The spectrum of trauma in geriatric patients includes head and spine injury, chest and rib trauma, blunt abdominal injury, pelvic fractures, and extremity fractures. Clinical evaluation of geriatric trauma patients is difficult because of overall frailty, comorbid illness, and medication effects. Specific attention should be focused on the effects of medications in this population, including anticoagulants, steroids, and bisphosphonates. Radiologists should use age-appropriate algorithms for radiography, computed tomography (CT), and magnetic resonance imaging of geriatric trauma patients and follow guidelines for intravenous contrast agent administration in elderly patients with impaired renal function. Because there is less concern about risk for cancer with use of ionizing radiation in this age group, CT is the primary imaging modality used in the setting of geriatric trauma. Clinical examples are provided from the authors' experience at a trauma center where geriatric patients who have sustained major and minor injuries are treated daily. PMID:26065932

  12. Heart failure - medicines

    MedlinePlus

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  13. Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review

    PubMed Central

    Keijsers, Carolina J P W; van Hensbergen, Larissa; Jacobs, Lotte; Brouwers, Jacobus R B J; de Wildt, Dick J; ten Cate, Olle Th J; Jansen, Paul A F

    2012-01-01

    AIMS Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms ‘pharmacology’ and ‘education’ in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1–935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given. PMID:22416832

  14. Targeting macrophages rescues age-related immune deficiencies in C57BL/6J geriatric mice.

    PubMed

    Jackaman, Connie; Radley-Crabb, Hannah G; Soffe, Zoe; Shavlakadze, Tea; Grounds, Miranda D; Nelson, Delia J

    2013-06-01

    Changes to innate cells, such as macrophages and myeloid-derived suppressor cells (MDSCs), during aging in healthy or tumor-bearing hosts are not well understood. We compared macrophage subpopulations and MDSCs from healthy young (6-8 weeks) C57BL/6J mice to those from healthy geriatric (24-28 months) mice. Spleens, lymph nodes, and bone marrow of geriatric hosts contained significantly more M2 macrophages and MDSCs than their younger counterparts. Peritoneal macrophages from geriatric, but not young, mice co-expressed CD40 and CX3CR1 that are usually mutually exclusively expressed by M1 or M2 macrophages. Nonetheless, macrophages from geriatric mice responded to M1 or M2 stimuli similarly to macrophages from young mice, although they secreted higher levels of TGF-β in response to IL-4. We mimicked conditions that may occur within tumors by exposing macrophages from young vs. geriatric mice to mesothelioma or lung carcinoma tumor cell-derived supernatants. While both supernatants skewed macrophages toward the M2-phenotype regardless of age, only geriatric-derived macrophages produced IL-4, suggesting a more immunosuppressive tumor microenvironment will be established in the elderly. Both geriatric- and young-derived macrophages induced allogeneic T-cell proliferation, regardless of the stimuli used, including tumor supernatant. However, only macrophages from young mice induced T-cell IFN-γ production. We examined the potential of an IL-2/agonist anti-CD40 antibody immunotherapy that eradicates large tumors in young hosts to activate macrophages from geriatric mice. IL-2-/CD40-activated macrophages rescued T-cell production of IFN-γ in geriatric mice. Therefore, targeting macrophages with IL-2/anti-CD40 antibody may improve innate and T-cell immunity in aging hosts. PMID:23442123

  15. Geriatric oncology: comparing health related quality of life in head and neck cancer patients

    PubMed Central

    2011-01-01

    Background Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care. This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients. Methods Two hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (≥ 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used. Results Head and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group. The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue. At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed. We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions. Conclusions Geriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co

  16. Addressing ethical issues in geriatrics and long-term care: ethics education at the Baycrest Centre for Geriatric Care.

    PubMed

    Gordon, M; Turner, L; Bourret, E

    2000-01-01

    An innovative program in ethics education exists at Baycrest Centre for Geriatric Care. This program can serve as a helpful model for long-term care and geriatric care facilities seeking to implement formal training programs in bioethics. Various aspects of the ethics education program are examined. In addition to describing the role of the ethics committee and research ethics board, consideration is given to case consultations, ethics rounds, the training of junior physicians and medical students, grand rounds and the planning of conferences and guest lectures. With regard to educational content in bioethics, health law, professional guidelines and the principlist approach of Beauchamp and Childress are used to explore the ethical dimensions of particular cases. Given the clinical context of the educational initiatives, the pedagogical approach is predominately case-based. While the bioethics literature emphasizes the patient-physician relationship, ethics education at Baycrest recognizes the importance of multiple professions. Physicians, nurses, social workers, speech pathologists, nutritionists and other health care providers are involved in ethical deliberation and education. PMID:11143884

  17. Student perceptions of the care of children: impacts of pre-clerkship pediatric and primary care clinical teaching

    PubMed Central

    Karras, Beverley; Selvaraj, Saumya; McConnell, Athena; Andres, Deirdre; Trinder, Krista; McKague, Meredith

    2014-01-01

    Background Pediatric clinical skills teaching sessions provide an early opportunity for students to be exposed to the medical care of children. This report describes second and third year medical students’ perceptions of and attitudes towards working with children before and after the pediatric clinical skills teaching sessions, and the experiences of those students precepted by pediatricians only compared to those students working with a combination of pediatricians and family physicians. Method A 13 question survey was voluntarily completed before and after teaching sessions. Written reflective assignments were qualitatively analyzed for key themes. Response rate averaged 68% with class sizes of 84 and 85 students. Results Students’ perceptions of the care of children were generally very positive. Some differences were found based on gender, phase of study and prior clinical exposure to pediatric care. Pre and post responses were similar, regardless of preceptor specialty. Students with family physician preceptors identified the themes of prevention, health promotion and multidisciplinary care in their reflections. Conclusions Students had already formed positive attitudes toward the medical care of children and intended to care for children in their future practice. Further research is needed into the effects of pre-clerkship experiences in the care of children on choice of medical specialty. PMID:26451220

  18. Offshore Medical Schools Are Buying Clinical Clerkships in U.S. Hospitals: The Problem and Potential Solutions.

    PubMed

    Halperin, Edward C; Goldberg, Robert B

    2016-05-01

    U.S. medical education faces a threat from for-profit Caribbean medical schools which purchase clinical rotation slots for their students at U.S. hospitals. These offshore schools are monetizing a system that was previously characterized as a duty-the duty of the current generation of physicians to educate their successors. Offshore schools purchase clinical rotation slots using funds largely derived from federally subsidized student loans. This leads to pressure on U.S. schools to pay for clinical clerkships and is forcing some of them to find new clinical training sites.For-profit Caribbean schools largely escape the type of scrutiny that U.S. schools face from U.S. national accreditation organizations. They also enroll large classes of students with lower undergraduate GPAs and Medical College Admission Test scores than those of students at U.S. medical schools; their students take and pass Step 1 of the United States Medical Licensing Examination at a substantially lower rate than that of U.S. medical students; and their students match for residencies at a fraction of the rate of U.S. medical school graduates.Among the potential solutions proposed by the authors are passing laws to hold for-profit Caribbean schools to standards for board passage rates, placing restrictions on federal student loans, monitoring attrition rates, and denying offshore schools access to U.S. clinical training sites unless they meet accreditation standards equivalent to those of U.S. medical schools. PMID:26910896

  19. Impact of the Liaison Committee on Medical Education requirements for emergency medicine education at U.S. schools of medicine.

    PubMed

    McLaughlin, Steven A; Hobgood, Cherri; Binder, Louis; Manthey, David E

    2005-10-01

    The Liaison Committee on Medical Education (LCME) accredits complete and independent medical education programs leading to the MD degree. The LCME standards for accreditation are described in the online document "Functions and Structure of a Medical School." There are ongoing minor and major changes to these standards. This article examines how the newest LCME requirements may affect emergency medicine (EM) rotations. The descriptions focus on 1) how the LCME requirements affect EM educational activities and 2) how the department of EM can help the school of medicine meet the LCME requirements. The recommendations focus on the general areas of the instructional setting, components of the educational program, resources for medical students, and faculty development. The department of EM can provide the students at the school of medicine with a number of key experiences and opportunities through its educational offerings and graduate medical education programs that will help satisfy the LCME standards. The new LCME standards will also have a significant impact on the way EM educators/clerkship directors develop curricula, assess students, provide feedback, and develop their own faculty/residents as teachers. The leadership of EM should recognize their increasingly important role within the school of medicine and be sensitive to additional requirements for faculty development and scholarship. PMID:16204146

  20. Actualizing a mobile integrated system for geriatric care.

    PubMed

    Chew, Han Ei; Faber, Johannes; Liu, Zhiming; Madera, Vanessa; Qamar, Nafees

    2013-01-01

    Population aging looms over countries all over the world. The social and economic implications of this phenomenon extend beyond the individual person and the immediate family, affecting broader society and the global community in profound ways. Aging populations increase pressure on already over-burdened public health care services and expenditures. To address this impending predicament, many health care providers and countries have turned to technological solutions. The near-ubiquity of mobile devices entails that mHealth will rapidly become a key component of technologically-enabled health care delivery services. This poster presents research and engineering challenges for a sustainable ICT solution that supports information exchange for mobile geriatric care. PMID:23920883

  1. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects].

    PubMed

    Belin, J; Houéto, J L; Constans, T; Hommet, C; de Toffol, B; Mondon, K

    2015-12-01

    Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects. PMID:26573332

  2. Pelvic radiation therapy for gynecologic malignancy in geriatric patients

    SciTech Connect

    Grant, P.T.; Jeffrey, J.F.; Fraser, R.C.; Tompkins, M.G.; Filbee, J.F.; Wong, O.S.

    1989-05-01

    Thirty-one patients, aged 75 years or older, who received pelvic radiation therapy as part of primary treatment for a gynecologic malignancy, were reviewed. Ten patients (32%) failed to complete their treatment and 4 patients (13%) died of treatment-related complications. The treatment-related complications were independent of increasing age, but did correlate closely with the patients' pretreatment ECOG performance status. Ten patients with performance levels of 2 or higher had a mortality rate of 30%, while 70% failed to complete treatment. Treatment fractions of greater than 220 cGy per day also resulted in unacceptably high complication rates. Alternative treatment formats should be considered in geriatric patients with poor initial performance levels.

  3. The prevalence of drivers in acute geriatric wards.

    PubMed Central

    Morgan, R.; Turnbull, C. J.; King, D.

    1995-01-01

    An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents. PMID:8545286

  4. Recent Advances in Neuroimaging Biomarkers in Geriatric Psychiatry

    PubMed Central

    Khandai, Abhisek C.; Aizenstein, Howard J.

    2013-01-01

    Neuroimaging, both structural and functional, serve as useful adjuncts to clinical assessment, and can provide objective, reliable means of assessing disease presence and process in the aging population. In the following review we briefly explain current imaging methodologies. Then, we analyze recent developments in developing neuroimaging biomarkers for two highly prevalent disorders in the elderly population- Alzheimer's disease (AD) and late-life depression (LLD). In AD, efforts are focused on early diagnosis through in vivo visualization of disease pathophysiology. In LLD, recent imaging evidence supports the role of white matter ischemic changes in the pathogenesis of depression in the elderly, the “vascular hypothesis.” Finally, we discuss potential roles for neuroimaging biomarkers in geriatric psychiatry in the future. PMID:23636984

  5. Xerostomia in the Geriatric Patient: Causes, Oral Manifestations, and Treatment.

    PubMed

    Ouanounou, Aviv

    2016-05-01

    Xerostomia, or dry mouth, is common among elderly people and is typically associated with decreased salivary gland function. Causes of xerostomia in the geriatric population have been attributed to the use of medications, chronic disorders, and radiation therapy to the head and neck region. Patients with chronic xerostomia may have multiple oral and dental consequences such as dental caries, periodontal disease, fungal infections, ill-fitting dentures, and taste alterations. Xerostomia can seriously impact quality of life and may alter speech, eating, and swallowing. Current therapeutics for the management of xerostomia are grouped as local and systemic salivary stimulation. This article reviews the main reasons for xerostomia and the complications it causes in the oral cavity. It also discusses the pharmacologic and nonpharmacologic agents used to treat this condition. PMID:27213776

  6. Comprehensive geriatric assessment of a patient with complex needs.

    PubMed

    Birch, Deborah

    2016-05-01

    This is the third in a short series that presents case study examples of the application of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic assessment model, which is designed to determine a frail older person's medical and mental health status, as well as functional, social and environmental issues. When undertaken by nurses, it can enable individualised care planning. The case study presented explores the application of CGA with an 89-year-old patient with complex health and social care needs. It demonstrates how a hospital admission was avoided and the patient's health outcomes improved, by using a nurse-led systematic approach to assessment and by careful consideration of CGA domains. PMID:27125938

  7. [LIMITATIONS OF THE BIOMEDICAL PARADIGM IN GERIATRICS INSTITUTIONS].

    PubMed

    Robledo, María Laura; Cabello, Cecilia; Dahl, Silvina

    2015-01-01

    The social perception of ageing related to the loss of both physical and psychological functions that determine in many cases the institutionalization of the elderly in nursing homes, leads to a medical care focused on a biomedical model, centered on organic factors as determinants of the illness. Illness is not an isolated condition in an individual, but has a subjective and social dimension. For this reason the biographic history becomes the main reference point in the care of the elderly. People experiment their disease within a narrative that gives a meaning to their experience; but this is not considered by the biomedical model, where the psychosocial factors that influence the onset or progression of the pathology are disregarded. This article attempts to explore the problem that arises when the care of the elderly that reside in geriatric institutions is centered on the biomedical model. PMID:26650415

  8. Pharmaceutical services in a capitated geriatric care program.

    PubMed

    Sorrento, T A; Bonanza, K C; Salisbury, D W

    1996-12-01

    A hospital outpatient pharmacy's planning and implementation of pharmaceutical services for a capitated geriatric care program are described. The hospital's director of pharmacy and pharmacy ambulatory care manager proposed providing distributive and clinical services for enrollees in Independent Living for Seniors (ILS), a program designed to help elderly persons to continue living at home instead of in nursing homes. ILS receives pooled monthly payments from Medicare and Medicaid; a copayment is required of enrollees not eligible for Medicaid. Medical and social services are offered, primarily through adult daycare centers. Nurses at the centers monitor ILS enrollees regularly and help them manage their medications. After a year of negotiations with the program, the outpatient satellite of the hospital's inpatient pharmacy began providing services; one pharmacist was assigned to ILS. Problems with medication stock at the daycare centers were corrected. Conservative supplies of stock drugs (mostly nonprescription items) and medications to meet patients' needs between daily pharmacy deliveries were established. A new computerized medication administration record was developed. Once distributive services were in place, a pharmacy and therapeutics committee began establishing a formulary. The pharmacist functions as part of an interdisciplinary care team, providing education on drug use and managing costs; he reviews all patients' charts every four months and meets weekly with ILS staff to recommend changes in drug therapy. The cost of services provided by the hospital outpatient pharmacy averaged $77 per patient per month in the first year, compared with about $120 for the previous vendor. A hospital's ambulatory care pharmacy improved the pharmaceutical services provided to a capitated geriatric care program. PMID:8957345

  9. The growth of gerontology & geriatrics in the United States.

    PubMed

    Schneider, E L

    1992-05-01

    Since the confirmation of the Older American's Act (OAA) in 1965, the growth of gerontology and geriatrics, has literally come of age in the United States. Although individual aging courses were offered in higher education prior to passage of the OAA, few gerontology programs had been established. On campuses where gerontology courses were available, they represented electives connected with a pre-existing discipline, such as social work or family studies. However, 1965 was a watershed year for gerontology instruction since it heralded the provision of federal funding support, beginning with that of the Administration on Aging (AoA), to help develop, pilot, and oversee gerontological programs in American institutions of higher learning. Initially, instruction was at an undergraduate level, but later gerontology degree programs were established at the master's level, with the first gerontology degree program originating at North Texas State University, in 1967. This program was followed a year later (1968) by a program at the University of South Florida. While funding from AoA began in 1966, funding from other federal agencies (e.g., the Bureau of Health Professions (BHP); the National Institute on Aging (NIA); the National Institute of Mental Health (NIMH), Mental Disorders of Aging Branch; and the Veteran's Administration (VA))--the five agencies that became the basis for a 1984 and 1987 Report on Education and Training in Geriatrics and Gerontology,--did not begin until the mid 1970s. The mid 1970s reflected the growing awareness of the demographic shift in America and around the world, particularly in developed nations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1507509

  10. Geriatric dermatoses: a clinical review of skin diseases in an aging population.

    PubMed

    Jafferany, Mohammad; Huynh, Trung V; Silverman, Melissa A; Zaidi, Zohra

    2012-05-01

    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

  11. Preparing Social Work Students for Interprofessional Practice in Geriatric Health Care: Insights from Two Approaches

    ERIC Educational Resources Information Center

    Bonifas, Robin P.; Gray, Amanda K.

    2013-01-01

    Although several interprofessional education projects have addressed training allied health students for effective teamwork in geriatrics, few curriculum evaluation studies have examined differences in learning outcomes between interprofessional and traditional uniprofessional approaches, especially for social work students. This paper compares…

  12. 78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... Affairs (VA) gives notice under the Federal Advisory Committee Act, 5 U.S.C. App. 2, that a meeting of the... dementia and program advances in palliative care, and performance and oversight of VA Geriatric...

  13. 78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... Veterans Affairs (VA) gives notice under the Federal Advisory Committee Act, 5 U.S.C. App. 2, that a... planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and...

  14. A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7

    PubMed Central

    Kim, Jin Won; Kim, Se-Hyun; Kim, Yu Jung; Lee, Keun-Wook; Kim, Kwang-Il; Lee, Jong Seok; Kim, Cheol-Ho; Kim, Jee Hyun

    2015-01-01

    Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92−0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85–0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73−0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention. PMID:26401951

  15. A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7.

    PubMed

    Kim, Jin Won; Kim, Se-Hyun; Kim, Yu Jung; Lee, Keun-Wook; Kim, Kwang-Il; Lee, Jong Seok; Kim, Cheol-Ho; Kim, Jee Hyun

    2015-01-01

    Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92-0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85-0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73-0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention. PMID:26401951

  16. Cross-cultural challenges for assessing medical professionalism among clerkship physicians in a Middle Eastern country (Bahrain): feasibility and psychometric properties of multisource feedback

    PubMed Central

    Al Ansari, Ahmed; Al Khalifa, Khalid; Al Azzawi, Mohamed; Al Amer, Rashed; Al Sharqi, Dana; Al-Mansoor, Anwar; Munshi, Fadi M

    2015-01-01

    Background We aimed to design, implement, and evaluate the feasibility and reliability of a multisource feedback (MSF) system to assess interns in their clerkship year in the Middle Eastern culture, the Kingdom of Bahrain. Method The study was undertaken in the Bahrain Defense Force Hospital, a military teaching hospital in the Kingdom of Bahrain. A total of 21 interns (who represent the total population of the interns for the given year) were assessed in this study. All of the interns were rotating through our hospital during their year-long clerkship rotation. The study sample consisted of nine males and 12 females. Each participating intern was evaluated by three groups of raters, eight medical intern colleagues, eight senior medical colleagues, and eight coworkers from different departments. Results A total of 21 interns (nine males and 12 females) were assessed in this study. The total mean response rates were 62.3%. A factor analysis was conducted that found that the data on the questionnaire grouped into three factors that counted for 76.4% of the total variance. These three factors were labeled as professionalism, collaboration, and communication. Reliability analysis indicated that the full instrument scale had high internal consistency (Cronbach’s α 0.98). The generalizability coefficients for the surveys were estimated to be 0.78. Conclusion Based on our results and analysis, we conclude that the MSF tool we used on the interns rotating in their clerkship year within our Middle Eastern culture provides an effective method of evaluation because it offers a reliable, valid, and feasible process. PMID:26316836

  17. The dilemma of implantable cardioverter-defibrillator therapy in the geriatric population

    PubMed Central

    Revenco, Diana; Morgan, James P; Tsao, Lana

    2011-01-01

    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. PMID:22783305

  18. Prolongevity medicine: Antagonic-Stress drug in distress, geriatrics, and related diseases. II. Clinical review--2003.

    PubMed

    Riga, S; Riga, D; Schneider, F

    2004-06-01

    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

  19. Mindfulness: Reconnecting the Body and Mind in Geriatric Medicine and Gerontology

    ERIC Educational Resources Information Center

    Rejeski, W. Jack

    2008-01-01

    Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the…

  20. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    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. PMID:21498881

  1. Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

    PubMed Central

    Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L

    1989-01-01

    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. PMID:2504064

  2. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.

    PubMed

    Schiphorst, A H W; Ten Bokkel Huinink, D; Breumelhof, R; Burgmans, J P J; Pronk, A; Hamaker, M E

    2016-05-01

    Treatment decisions for elderly cancer patients can be challenging. A geriatric assessment may identify unknown medical conditions, give insight on patients' ability to tolerate treatment and guide treatment decisions. Our aim was to study the value of a geriatric consultation in oncological decision-making. Data on cancer patients referred for geriatric consultation for clinical optimisation or due to uncertainty regarding their optimal treatment strategy were prospectively analysed. Outcome of geriatric evaluations, non-oncological interventions and suggested adaptations of oncological treatment proposals were evaluated. Seventy-two patients were referred for consultation, over half of which in a curative treatment setting. Prevalence of geriatric syndromes was 93%, previously undiagnosed conditions were identified in 49% of patients and non-oncological interventions were initiated in 56%. Time was spent discussing patients' priorities (53% of consultations), expectations on treatment (50%) and advance care planning (14%). For 82% of patients, suggestions were made regarding the optimal treatment decision: a more intensive treatment was recommended in 39%, a less intensive therapy for 42% and in 19% only supportive care was suggested. The results demonstrate that a geriatric consultation can aid in complex treatment decisions and may allow for a reduction in over- and undertreatment of elderly cancer patients. PMID:26211484

  3. Engineering the fitness of older patients for chemotherapy: an exploration of Comprehensive Geriatric Assessment in practice.

    PubMed

    McCarthy, Alexandra L; Cook, Peta S; Yates, Patsy

    2014-03-01

    Clinicians often report that currently available methods to assess older patients, including standard clinical consultations, do not elicit the information necessary to make an appropriate cancer treatment recommendation for older cancer patients. An increasingly popular way of assessing the potential of older patients to cope with chemotherapy is a Comprehensive Geriatric Assessment. What constitutes Comprehensive Geriatric Assessment, however, is open to interpretation and varies from one setting to another. Furthermore, Comprehensive Geriatric Assessment's usefulness as a predictor of fitness for chemotherapy and as a determinant of actual treatment is not well understood. In this article, we analyse how Comprehensive Geriatric Assessment was developed for use in a large cancer service in an Australian capital city. Drawing upon Actor-Network Theory, our findings reveal how, during its development, Comprehensive Geriatric Assessment was made both a tool and a science. Furthermore, we briefly explore the tensions that we experienced as scholars who analyse medico-scientific practices and as practitioner-designers charged with improving the very tools we critique. Our study contributes towards geriatric oncology by scrutinising the medicalisation of ageing, unravelling the practices of standardisation and illuminating the multiplicity of 'fitness for chemotherapy'. PMID:23703221

  4. Herbal Medicine

    MedlinePlus

    ... for its scent, flavor, or therapeutic properties. Herbal medicines are one type of dietary supplement. They are ... and fresh or dried plants. People use herbal medicines to try to maintain or improve their health. ...

  5. Diabetes Medicines

    MedlinePlus

    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 ...

  6. Sarcopenia and frailty in geriatric patients: implications for training and prevention.

    PubMed

    Mühlberg, W; Sieber, C

    2004-02-01

    Sarcopenia, the loss of muscle mass and strength, is a constant phenomenon in aging. Physiologic age-dependent changes (drop in growth hormone (GH), IGF-1, menopause/andropause) explain the impaired protein synthesis, the decline of muscle mass, strength, and bone density. Harmful consequences of sarcopenia in old age are loss of muscle strength, inducing itself loss of mobility, neuromuscular impairment, and homeostatic balance failure syndrome with gait and balance disorders. All these sarcopenia-induced disabilities are important factors for an increased rate of falls and fractures in old age. Both falls and fractures cause hospitalisation and immobilisation which again induces sarcopenia. Once the physiological age-dependent decline of protein synthesis has started, some connected "vicious loops" occur in frail elderly patients, forming a typical pattern in geriatric medicine. There is a vicious loop between sarcopenia and immobilisation: sarcopenia --> neuromuscular impairment --> falls and fractures --> immobilisation --> sarcopenia. Another loop is the "nutritional" vicious loop between sarcopenia and malnutrition: sarcopenia --> immobilisation --> decline of nutrition skills ("empty refrigerator") --> malnutrition --> impaired protein synthesis --> sarcopenia. There is also a third "metabolic" vicious loop between sarcopenia and the decline of the protein reserve of the body: sarcopenia --> decline of the protein reserve of the body --> diminished capacity to meet the extra demand of protein synthesis associated with disease and injury --> sarcopenia. Frailty, a term not precisely defined, results from these different "vicious loops" including sarcopenia, neuromuscular impairment, falls and fractures, immobilisation, malnutrition, impaired protein synthesis, and decreased protein reserve of the body. Implications for training: main possibilities for training and prevention (of sarcopenia and frailty) are: a) continuous neuromuscular training (including

  7. Medicine Women.

    ERIC Educational Resources Information Center

    Beiswenger, James N., Ed.; Jeanotte, Holly, Ed.

    Described as a survival manual for Indian women in medicine, this collected work contains diverse pieces offering inspiration and practical advice for Indian women pursuing or considering careers in medicine. Introductory material includes two legends symbolizing the Medicine or Spirit Woman's role in Indian culture and an overview of Indians Into…

  8. Validation of screening tools to assess appetite among geriatric patients.

    PubMed

    Hanisah, R; Suzana, S; Lee, F S

    2012-07-01

    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

  9. Incorporating geriatrics into baccalaureate nursing curricula: laying the groundwork with faculty development.

    PubMed

    Latimer, Deborah G; Thornlow, Deirdre K

    2006-01-01

    In June 2001, the John A. Hartford Foundation of New York awarded the American Association of Colleges of Nursing (AACN) a 3.99 million dollar grant to enhance gerontology curriculum development and new clinical experiences in 20 baccalaureate and 10 graduate schools of nursing. Over the 4-year grant implementation period, AACN learned a valuable lesson from the grant's site directors: Faculty development is the single most necessary precursor to the successful implementation and maintenance of geriatric curricular enhancements. Unless faculty members foster positive attitudes toward aging, expand their geriatric nursing knowledge base, and are able to integrate geriatric content into the curricula, progress cannot be made. Enhancing Geriatric Nursing Education project directors recommend that the following steps be taken toward the creation of successful faculty development activities: (1) anoint a champion to mentor and persuade faculty members to embrace gerontology; (2) garner faculty buy-in by engaging the faculty early so that they become active participants in the curricular change process; (3) assess faculty knowledge and comfort level by administering tools developed by the John A. Hartford Foundation Institute for Geriatric Nursing and by conducting surveys based on AACN geriatric core competencies; (4) conduct faculty development workshops that include cutting-edge knowledge and research and provide the faculty with opportunities to discuss feelings and stereotypes about aging; (5) elicit the dean's support to encourage and allow time and opportunities for training; and (6) use the many excellent resources that help the faculty integrate geriatric content into their courses. This article will further elucidate such strategies and will highlight the range of faculty development activities in which grant-funded schools engaged. PMID:16564471

  10. Developing Leadership in Geriatric Education. Proceedings of the Annual Summer Geriatric Institute (5th, Lexington, Kentucky, July 23-25, 1990).

    ERIC Educational Resources Information Center

    Gardner, Davis L., Ed.; Patzwald, Gari-Anne, Ed.

    Papers in these proceedings are organized into four sections: (1) Research Studies in Aging; (2) Innovative Approaches in Geriatric Education; (3) Faculty Development Models; and (4) "The Publication Process: Perils and Pearls" (Workshop). Clinical Experiences: Design Not Chance" (Matzo); "The Development of a Collaborative Gerontological Research…

  11. Developments of geriatric autopsy database and Internet-based database of Japanese single nucleotide polymorphisms for geriatric research (JG-SNP).

    PubMed

    Sawabe, Motoji; Arai, Tomio; Kasahara, Ichiro; Esaki, Yukiyoshi; Nakahara, Ken-ichi; Hosoi, Takayuki; Orimo, Hajime; Takubo, Kaiyo; Murayama, Shigeo; Tanaka, Noriko

    2004-08-01

    To facilitate geriatric research on the roles of genetic polymorphisms of candidate genes, two databases were developed based on data obtained from autopsy examinations of elderly subjects: the geriatric autopsy database (GEAD) and the Japanese single nucleotide polymorphisms (SNP) database for geriatric research (JG-SNP) which is accessible on the Internet (http://www.tmgh.metro.tokyo.jp/jg-snp/english/E_top.html). The data for the GEAD were derived from 1074 consecutive autopsy cases (565 male and 509 female cases) with an average age of 80 years. The GEAD was installed on a stand-alone Windows 2000 server using Oracle 8i as the database application. The GEAD contains clinical diagnoses of 26 geriatric diseases, histories of smoking and alcohol consumption, pathological findings (720 items), severity of atherosclerosis, genetic polymorphism data, etc. On the JG-SNP website, case distribution corresponding to a specified SNP or disease can be searched or downloaded. Although there are several Internet-based SNP databases such as dbSNP, no databases are available at present on the web that contain both SNP data and phenotypic data. As autopsy studies can provide large amounts of accurate medical information, including the presence of undiagnosed diseases such as latent cancers, the GEAD is a unique and excellent database for research on genetic polymorphisms. PMID:15336912

  12. Evaluating Clinical Teaching in Medicine.

    ERIC Educational Resources Information Center

    Irby, David; Rakestraw, Philip

    1981-01-01

    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)

  13. Geriatric education centers address medication issues affecting older adults.

    PubMed Central

    Kahl, A; Blandford, D H; Krueger, K; Zwick, D I

    1992-01-01

    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. PMID:1738807

  14. A current perspective on geriatric lower urinary tract dysfunction

    PubMed Central

    Jung, Ha Bum; Kim, Hyung Jee

    2015-01-01

    Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction. PMID:25874039

  15. [Cases of prosthodontic tissue reconditioning in geriatric dentistry].

    PubMed

    Le Guern, J Y

    1990-03-01

    In elderly patients, recurrent fractures of the lower denture must raise the question of a neurological deficit as cause of the occluso-prosthetic imbalance. Hypotonicity of the peri-oral mastication musculature, especially the masseters, may explain the alteration of the prosthetic supporting surface due to shriveling of the mandibular arch, along with an osseogenesis at the point of flexion of the mandible. The rest and activity muscular imbalance, resulting from unilateral mastication, may cause lingual dysfunction and deviation of the tongue at rest. If this problem is not controlled within an acceptable period of time, one should expect psychological, biological and physiological consequences affecting the patient's physical condition. The restoration of the denture fracture is insufficient. Reconditioning must be performed in order to replace the existing prosthesis in the patient's function, allowing him/her to recover a normal psychological, biological and physiological balance. In conclusion, in geriatric dentistry, the objective of reconditioning is, not only to restore a functional occlusion, but also the psychological, biological and physiological balance of the patient. This is an unvaluable advantage, especially if this contributes to maintain or restore an often precarious health. PMID:2200568

  16. [Analgesics in geriatric patients. Adverse side effects and interactions].

    PubMed

    Gosch, Markus

    2015-07-01

    Pain is a widespread symptom in clinical practice. Older adults and chronically ill patients are particularly affected. In multimorbid geriatric patients, pharmacological pain treatment is an extension of a previously existing multimedication. Besides the efficacy of pain treatment, drug side effects and drug-drug interactions have to be taken into account to minimize the health risk for these patients. Apart from the number of prescriptions, the age-related pharmacokinetic and pharmacodynamic changes significantly increase the risk among older adults. The use of non-steroidal anti-inflammatory drugs (NSAID) is widespread but NSAIDs have the highest risk of adverse drug reactions and drug interactions. In particular, the gastrointestinal, cardiovascular, renal and coagulation systems are affected. Apart from the known toxic effect on the liver (in high doses), paracetamol (acetaminophen) has similar risks although to a lesser degree. According to current data, metamizol is actually better than its reputation suggests. The risk of potential drug interactions seems to be low. Apart from the risk of sedation in combination with other drugs, tramadol and other opioids can induce the serotonin syndrome. Among older adults, especially in the case of polypharmacy, an individualized approach should be considered instead of sticking to the pain management recommended by the World Health Organization (WHO) in order to minimize drug-drug interactions and adverse drug reactions. PMID:26152872

  17. The 3 D's of geriatric psychiatry: depression, delirium, and dementia.

    PubMed

    Dharia, Sheetal; Verilla, Kailen; Breden, Ericka L

    2011-08-01

    A Caucasian female octogenarian with multiple medical problems was admitted to the inpatient geriatric psychiatry unit with intermittent altered mental status and decline in memory. She had been hospitalized four times in the previous three months. She was admitted on more than 10 medications and received more than 20 different medications in this time period. It was determined that she had delirium concurrent with dementia and/or depression. During her hospital stay a urinary tract infection (UTI) was treated, her anticholinergic medications were minimized, and her digoxin dose was adjusted. As her mental status cleared, a workup was completed to differentiate between dementia and depression. She was initially treated with memantine, but as time progressed it became more evident she was experiencing depression and a "pseudodementia," which was treated with sertraline. Her Mini-Mental State Examination returned to 29/30 (her score previously was 26/29). This case demonstrates the complexity of treating an elder individual and the importance of differentiating among delirium, depression, and dementia. The pharmacy team played an active role in medication reconciliation. Additionally, they worked with the medical team to minimize her potentially harmful medications and optimize the treatment of her UTI and depression. PMID:21840820

  18. Delirium in the elderly: current problems with increasing geriatric age

    PubMed Central

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-01-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multfactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age. PMID:26831414

  19. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.

    PubMed

    Parham, Kourosh; Kuchel, George A

    2016-02-01

    Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach. PMID:26804483

  20. Decrease in Antioxidant Status of Plasma and Erythrocytes from Geriatric Population

    PubMed Central

    Kumawat, Manjulata; Sharma, Tarun Kumar; Singh, Ishwar; Singh, Neelima; Singh, Sanjeev Kumar; Ghalaut, Veena Singh; Shankar, Vijay; Vardey, Satish Kumar

    2012-01-01

    Background: Ageing is associated with an accumulation of free radical damage, which leads to physiological and clinical modifications. The study aims to find out the status of lipid profile, antioxidant enzymes, malondialdehyde in geriatric population. Patients/methods: The study was conducted on 150 subjects (75 healthy control between the ages of 20–30 years and 75 elderly subjects between ages of 50–70 years as cases). The following parameters were analyzed using the standard reference methods: lipid profile, reduced glutathione, glutathione peroxidase, glutathione reductase, catalase, superoxide dismutase and malondialdehyde. Results: The present study was conducted to estimate the oxidative stress parameters in geriatric population. Highly significant increase in total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), VLDL-cholesterol (VLDL-C), malondialdehyde, catalase and decrease in high density lipoprotein cholesterol (HDL-C), reduced glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase was observed in geriatrics when compared with their younger counterparts. Conclusion: This study concluded that there is enhanced oxidative stress and decreased antioxidant defence in geriatrics as compared to younger subjects which could play an important role in ageing. Dyslipidemia has become one of the important risk factors for the increasing prevalence of cardiovascular diseases. There is lack of awareness on the relationship between blood lipids and the risk of cardiovascular diseases in geriatric population. The strategy of early prevention should be adopted against dyslipidemia. PMID:23089922