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.
Diachun, Laura; Charise, Andrea; Goldszmidt, Mark; Hui, Yin; Lingard, Lorelei
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…
Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.
Description of Clerkships FAMILY MEDICINE Department of Family Medicine #12;2 Family Medicine the dimensions of the role of the family physician and the problem-solving approach of family medicine, community Normally six students rotate monthly in the Department of family medicine. Students receive didactic
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)
Family Medicine Clerkship MID-ROTATION EVALUATION The University of Chicago Division Please evaluate the student's level of skill in the following competencies in Family Medicine in Family Medicine 1. Involves and considers families in the care of patients in family medicine. 2
A study of the preceived acquisition of clinical skills by second-year medical students in six required clerkships is reported. The students completed self-assessments of their clinical skills when taking the family medicine clerkship. The principal contributions of the family medicine clerkship were in the management of common problems.…
Michener, J. Lloyd; And Others
A new medicine clerkship curriculum started in 1981 at Dartmouth Medical School to ensure high quality teaching independent of teaching by members of the house staff and by attending physicians is described. Improved residency performance ratings of the medical school graduates have been the result. (MLW)
Regan-Smith, Martha G.
Objective Feedback is a technique used in medical education to help develop and improve clinical skills. A comprehensive review article specifically intended for the emergency medicine (EM) educator is lacking, and it is the intent of this article to provide the reader with an in-depth, up-to-date, and evidence-based review of feedback in the context of the EM clerkship. Methods The review article is organized in a progressive manner, beginning with the definition of feedback, the importance of feedback in medical education, the obstacles limiting the effective delivery of feedback, and the techniques to overcome these obstacles then follows. The article concludes with practical recommendations to implement feedback in the EM clerkship. To advance the literature on feedback, the concept of receiving feedback is introduced. Results The published literature regarding feedback is limited but generally supportive of its importance and effectiveness. Obstacles in the way of feedback include time constraints, lack of direct observation, and fear of negative emotional responses from students. Feedback should be timely, expected, focused, based on first-hand data, and limited to behaviors that are remediable. Faculty development and course structure can improve feedback in the EM clerkship. Teaching students to receive feedback is a novel educational technique that can improve the feedback process. Conclusion Feedback is an important educational technique necessary to improve clinical skills. Feedback can be delivered effectively in the EM clerkship. PMID:22224156
Bernard, Aaron W; Kman, Nicholas E; Khandelwal, Sorabh
Several studies published in 2008 underline the potential danger of polymedication in older patients and propose indicators to identify those at higher risk for adverse events. A study from Oregon highlighted the difficulties to diagnose depression in patients, especially older ones, who made a request for assisted suicide. The HYVET study demonstrated that treatment of hypertension is beneficial even in some very old persons. A meta-analysis confirmed the benefits from community-based geriatric interventional programs, in particular when targeting older individuals recently discharged from the hospital. Finally, mixed results were observed in the field of dementia. PMID:19216320
Monod, Stéfanie; Rochat, Stéphane; Gold, Gabriel; Büla, Christophe
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)
Michener, J. Lloyd; And Others
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…
Parkerson, George R., Jr.; And Others
The process used by the Society of Teachers of Family Medicine to develop core curriculum guidelines for third-year family medicine clerkships is described, the guidelines are presented, and dissemination, implementation, and further development activities are outlined. The work was supported by a Department of Health and Human Services grant.…
Academic Medicine, 1991
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…
O'Hara, Brenda S.; Saywell, Robert M., Jr.; Zollinger, Terrell W.; Smith, Christopher P.; Burba, Jennifer L.; Stopperich, David M.
Introduction As emergency medicine (EM) has become a more prominent feature in the clinical years of medical school training, national EM clerkship curricula have been published to address the need to standardize students’ experiences in the field. However, current national student curricula in EM do not include core pediatric emergency medicine (PEM) concepts. Methods A workgroup was formed by the Clerkship Directors in Emergency Medicine and the Pediatric Interest Group of the Society of Academic Emergency Medicine to develop a consensus on the content to be covered in EM and PEM student courses. Results The consensus is presented with the goal of outlining principles of pediatric emergency care and prioritizing students’ exposure to the most common and life-threatening illnesses and injuries. Conclusion This consensus curriculum can serve as a guide to directors of PEM and EM courses to optimize PEM knowledge and skills education.
Askew, Kim L.; Weiner, Debra; Murphy, Charles; Duong, Myto; Fox, James; Fox, Sean; O'Neill, James C.; Nadkarni, Milan
Abstract Continuing the momentum of geriatric palliative medicine research achieved during the past decade requires a focus on research methods priorities that span the continuum of research from small pilot studies testing new interventions to large multisite studies evaluating implementation of proven interventions and models of care. Each phase of this continuum presents unique challenges for investigators who are designing, conducting, and reporting results of these scientific endeavors. The goal of this article is to describe the top priorities in research methods for the field of geriatric palliative medicine that will enable the field to rapidly respond to the changing landscape of health care policy and quality improvement initiatives. PMID:23777330
The authors report their findings concerning the process used to evaluate medicine clerks, specifically identifying the importance given to subjective evaluations, made by attending physicians, compared with the importance given to clerks' performances on objective means of evaluation based on written or oral examinations, whether national or…
Magarian, Gregory J.; Mazur, Dennis J.
researchers pioneer new methods to assess health and frailty Marian Shannon broke her left thigh bone justGERIATRIC MEDICINE CAPITAL HEALTH RESEARCH Page 1 CAPITAL HEALTH -- RESEARCH FOCUS ON Many people experience increasingly debilitating health problems as they age. Capital Health clinicians and researchers
Recent studies by the Institute of Medicine, part of the National Academy of Sciences, and the Rand Corporation have suggested that most physicians in the United States are inadequately trained to cope with the care of the elderly, in spite of the fact that over 11% of the population is over age 65. At present, nearly 30% of all health care…
In Iran, a large group of patients are elderly people and they intend to have natural remedies as treatment. These remedies are rooted in historical of Persian and humoral medicine with a backbone of more than 1000 years. The current study was conducted to draw together medieval pharmacological information related to geriatric medicine from some of the most often manuscripts of traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plants through a search of the PubMed, Scopus and Google Scholar databases. In the medieval Persian documents, digestible and a small amount of food such as chicken broth, honey, fig and plum at frequent intervals as well as body massage and morning unctioning are highly recommended. In the field of pharmacotherapy, 35 herbs related to 25 families were identified. Plants were classified as tonic, anti-aging, appetizer, memory and mood enhancer, topical analgesic and laxative as well as health improvement agents. Other than historical elucidation, this paper presents medical and pharmacological approaches that medieval Persian practitioners applied to deal with geriatric complications. PMID:24381461
Emami, Morteza; Sadeghpour, Omid; Zarshenas, Mohammad M
SUBJECT EXAM TESTING DATES BY CLERKSHIP -2012-2013 FAMILY MEDICINE NEUROLOGY PEDIATRICS PSYCHIATRY SUBJECT EXAM SCHEDULE 8:00 AM Â Pediatrics, Family Medicine, Psychiatry and Surgery 11:00 AM Â Medicine
The UK's population is ageing and an adequately staffed geriatric medicine workforce is essential for high quality care. We evaluated the current and future geriatric medicine workforce, drawing on data relating to the UK population, current geriatric medicine consultants and trainees, recruitment into the specialty and trainee career progression. Data were derived from various sources, including the British Geriatrics Society Education and Training Committee biannual survey of training posts. The demographic of consultant geriatricians is changing and so too are their job plans, with more opting to work less than full time. The number of applicants to geriatric medicine training is increasing, yet increasing numbers of posts remain unfilled (4.7% in November 2010 and 14.1% in May 2013). The majority of geriatric medicine trainees secure a substantive consultant post within 6 months of obtaining their certificate of completion of training This work highlights challenges for the future: potential barriers to trainee recruitment, unfilled training posts and an ageing population and workforce. PMID:24715117
Fisher, James M; Garside, Mark; Hunt, Kelly; Lo, Nelson
OBJECTIVE To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN Two-round Delphi technique. PARTICIPANTS The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS Using 1–5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM–CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4.0), and for individual students (3.8). CONCLUSION Clerkship directors identified test content that was relevant to the curricular content and important for clerkship students to know, and they indicated a desired question distribution. They would most like feedback on their students' performance by organ system–based sections for the complete academic year. This collaborative effort could serve as a model for aligning national exams with course goals. PMID:12133157
Elnicki, D Michael; Lescisin, Dianne A; Case, Susan
The use of complementary and alternative veterinary medicine continues to grow within the veterinary community. As more clients seek out complementary and alternative medicine for their own health care, they begin to seek out these forms of therapy for their animals. For the equine practitioner, this includes those clients with geriatric animals. It is hoped that this article provides some insight into what conditions may be helped with CVM (complementary veterinary medicine) and when an equine practitioner may want to consider CVM as a form of therapy for the geriatric horse. PMID:12516938
This study aims to determine the feasibility of incorporating structured therapeutic consultations (TCs) into the clinical clerkship internal medicine. TCs were considered feasible if students were able to draw up a therapeutic plan and carry out a TC, and if students and their supervisors considered TCs workable and useful. From March 2008 to October 2009, medical students carried out a "diagnostic" and subsequent "therapeutic" consultation with the same patient during their clinical clerkship internal medicine at the VU University Medical Center. After the diagnosis was established, the student had to formulate a therapeutic plan and then carry out a TC with the patient, supervised by a clinician. The supervisor assessed the therapeutic plan and how the student conducted the TC. Both the student and the supervisor received a questionnaire about the workability and usefulness of the TC. On average, students' performance in drawing up a therapeutic plan was awarded a score of 4.4 on a five-point scale, and the TC performance of 96 % of the students was considered amply sufficient or better. Eighty-three percent of the supervisors agreed or strongly agreed with the statement that the TC is a worthwhile addition to the clerkship, and 67 % of the students indicated that they would like to perform more TCs. This study shows that incorporating a structured TC with a real patient into the clinical clerkship internal medicine is both feasible and worthwhile. This may be an important step to improving the prescribing skills and attitudes of junior doctors and residents and to reducing their prescribing errors after graduation. PMID:22899175
van Unen, R J; Tichelaar, J; Schneider, A J; Geijteman, E C T; Nanayakkara, P W B; Thijs, A; Richir, M C; de Vries, Th P G M
PURPOSE Anxiety is thought to affect test performance. Studies have shown that students with low levels of test anxiety achieve higher scores on multiple choice question (MCQ) examinations than those with high anxiety levels. Female students have been shown to have higher test anxiety levels than male students. Standardized patient (SP) examinations are being used in medical schools and for licensing purposes. As SP exams are relatively new, there are few studies measuring anxiety levels for the SP test. The purpose of this study was to measure and compare medicine clerkship student SP versus MCQ examination anxiety levels and to determine if level affected test performance. METHODS The Spielberger test attitude inventory was used to measure anxiety in 150 students rotating through the clerkship. Students completed questionnaires after the MCQ and SP examinations. Mean examination scores and anxiety levels were compared. Based on questionnaire scores, students were divided into 3 groups: low, moderate, and high anxiety. The MCQ and SP examination scores were analyzed to determine if male/female anxiety-level affected test performance. RESULTS There were no meaningful anxiety-level differences between the SP and MCQ examinations. An inverse relationship between anxiety level and test scores was not identified. Female students had higher anxiety levels but sex differences did not influence examination performance. DISCUSSION Medicine clerkship student test performance is not affected by anxiety level. Implications of the findings for incorporating stress management training in medical school curricula and suggestions for future research are discussed. PMID:16704380
Clerkships Blocks Weeks State - Location IPCC BLOCK Family Medicine 8 AK- Yukon-Kuskokwim Delta Regional Hospital, Bethel, AK AZ- Indian Health Service Hospital, Tuba City, AZ FL- University of Miami- Brown U/Memorial Hospital of RI, Pawtucket, RI Regional Sites (various practice sites in NH/VT) Medicine
Myers, Lawrence C.
Background: Abstracts presented at meetings may be a reflection of the meeting's quality. Summary: The goal is to determine purpose, content areas, research design, and subsequent publication rates of abstracts presented at Clerkship Directors in Internal Medicine's annual meetings. Abstracts presented in 1995–2005 were analyzed. A total of 201 abstracts were analyzed and coded. The purpose of the majority of
Klara K. Papp; Elizabeth A. Baker; Liselotte N. Dyrbye; D. Michael Elnicki; Paul A. Hemmer; Alex J. Mechaber; Matthew Mintz; Steven J. Durning
Objective This study investigated third-year students’ experience with the emergency medicine (EM) component in integrated longitudinal programs. The study aimed to see if EM could be integrated into third-year integrated longitudinal programs while addressing accreditation standards and increasing interest in EM. Methods The authors surveyed students who participated in an integrated longitudinal program at University of California San Francisco School of Medicine (UCSF) from 2010 to 2012. The survey focused on four areas of EM: fit within an integrated longitudinal program; development of critical decision-making and judgment skills; development of differential diagnoses and treatment plans; increased interest in pursuing EM. Results Overall, students thought that EM fits well with the goals of an integrated longitudinal curriculum. They also thought that it helped them develop their decision-making, clinical judgment, differential diagnoses, and treatment plans. There was also an increased interest in pursuing EM as a career option because of the EM component. Conclusions EM can be well integrated into a third-year longitudinal curriculum. The undifferentiated patient work-up helps students develop critical skills in assessment and management. The lack of continuity did not interfere with the integrated longitudinal curriculum, instead the experience enhanced it. PMID:25227527
Banh, Kenny; Ramirez, Rene; Thabit, Christina
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…
Rollins, Lisa K.; Martirosian, Tovia; Gazewood, John D.
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 MRT experience involving third-year medical students on their Family Medicine clerkship and volunteer
Johanna Shapiro; Beverly Cho
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)
Duque, Gustavo; Bonnycastle, Michael; Nazerali, Najmi; Bailey, Robert; Ferrier, Catherine; Heilpern, Paul; Gold, Susan
Updated 8/27/2014 CORE CLERKSHIPS CLER 656: REQUIRED FAMILY MEDICINE CORE Clerkship Director, pediatrics, obstetrics/gynecology and surgery prior to family medicine. Methods of Evaluation Day and exceed expected parameters of national standards in family medicine 4.Prepare students for required NBME
A challenging aspect of geriatric practice is that it often requires decision-making under conditions of uncertainty. The Script Concordance Test (SCT) is an assessment tool designed to measure clinical data interpretation, an important element of clinical reasoning under uncertainty. The purpose of this study was to develop and analyze the validity of results of an SCT administered to undergraduate students in geriatric medicine. An SCT consisting of 13 cases and 104 items covering a spectrum of common geriatric problems was designed and administered to 41 undergraduate medical students at a medical school in São Paulo, Brazil. A reference panel of 21 practicing geriatricians contributed to the test's score key. The responses were analyzed, and the psychometric properties of the tool were investigated. The test's internal consistency and discriminative capacity to distinguish students from experienced geriatricians supported construct validity. The Cronbach alpha for the test was 0.84, and mean scores for the experts were found to be significantly higher than those of the students (80.0 and 70.7, respectively; P < .001). This study demonstrated robust evidence of reliability and validity of an SCT developed for use in geriatric medicine for assessing clinical reasoning skills under conditions of uncertainty in undergraduate medical students. These findings will be of interest to those involved in assessing clinical competence in geriatrics and will have important potential application in medical school examinations. PMID:23036106
Piovezan, Ronaldo D; Custódio, Osvladir; Cendoroglo, Maysa S; Batista, Nildo A; Lubarsky, Stuart; Charlin, Bernard
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
Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne
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
Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S
The specialism of geriatric medicine has developed considerably in the last half of the twentieth century. In Great Britain it has emerged from its sombre beginnings in Victorian poor law institutions to become one of the largest specialities in medicine encompassing a wide range of disciplines and interests. More recently, there has been a parallel development in "intermediate care" a sweeping phrase that encompasses a wide diversity of practices in a plethora of venues. Although there is considerable attraction in minimising the duration of hospital stay by older people, there is a real risk of intermediate care being used as a euphemism for indeterminate neglect. For older people to benefit from appropriate treatment and care, the lessons learnt by earlier generations of geriatricians, and supported by the international evidence base should not be disregarded. Elderly people need a full multi-disciplinary assessment (comprehensive geriatric assessment) and continued involvement of skilled and trained personnel in their continuing care (geriatric evaluation and management). The recommendations of the British Geriatrics Society on intermediate care are commended and should be adhered to by all planners and providers of intermediate care. There is considerable logic in developing ways in which the two developments can be integrated to build upon the best features of both. PMID:11511484
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 accessible. Fellows reflected on aspects relevant to postgraduate training and future practice and documented adherence
Jorge G. Ruiz; Syeda S. Qadri; Marina Karides; Carmen Castillo; Marcos Milanez; Bernard A. Roos
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
Williams, C M; Petrelli, J; Murphy, M
Advocating Vaccination of Adults Aged 60 Years and Older in Western Europe: Statement by the Joint Vaccine Working Group of the European Union Geriatric Medicine Society and the International Association of Gerontology and Geriatrics-European Region
Vaccines are an underused public health strategy for healthy aging. Considering the risks of vaccine-preventable diseases and the current low vaccine coverage rates in older European citizens, the two European geriatric and gerontological societies (European Union Geriatric Medicine Society (EUGMS) and International Association of Gerontology and Geriatrics-European Region (IAGG-ER)) convened a Joint Vaccine Working Group to de- velop a consensus
Jean-Pierre Michel; Christian Chidiac; Beatrix Grubeck-Loebenstein; Robert W. Johnson; Paul Henri Lambert; Stefania Maggi; Robert Moulias; Karl Nicholson; Hans Werner
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
Holden, W D
the learning objectives of the STFM Family Medicine Clerkship Curriculum. Cases build clinical competency, fill educational gaps, and help instill the core values and attitudes of family medicine. fm and is acceptable for up to 60 Prescribed credits by the AAFP. Each Family Medicine Case is approved for up to 1
Maxwell, Bruce D.
OBJECTIVE: \\u0009To teach 3rd year medical students in a Family Medicine rotation the concepts and methods required to practice Evidence-Based Medicine and how to search for that evidence. The course was developed with an emphasis on finding resources and included an extensive epidemiological and statistical component. Using student evaluations, the evolution over five years will be explored.\\u000aMETHODS: \\u0009The didactic
Len L Levin; James F. Comes
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
Siddiqui, Mohammad Jamshed; Min, Chan Sze; Verma, Rohit Kumar; Jamshed, Shazia Qasim
Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the context of geriatric medicine and gerontology. Upon reviewing definitions and models of the concept, I give attention to the unique role that the body plays in cultivating mindfulness and the advantages that this focus has for older adults because they have aging biological systems and may experience chronic disease, pain, and disability. In the final section I discuss why mindfulness may be particularly useful in promoting physical activity among older adults and how physical activity may be used as a vehicle to promote mindfulness. PMID:18483425
Rejeski, W. Jack
Year 4 Neurology Clerkship Clerkship description by Mo Levin Summary of clerkship (Mo Levin) 1a. Faculty status of teachers at all sites (Mo Levin) 2 and diagnoses 2 #12;1. Descrip(on of Clerkship Provided by Mo Levin Summary
Myers, Lawrence C.
This study evaluated the presence of eight geriatric care Institute of Medicine (IOM) recommendations in a representative sample of hospitals (N = 128) that provide care to injured older adults. Four data sources were utilized to form a dataset. Descriptive statistics were conducted and Chi-square analyses were used to examine differences among trauma center levels and non-trauma centers. Six IOM recommendations were present in less than 50% of hospitals. Recommendations related to computerized support for risk assessment of two geriatric-specific conditions (CAUTI, pressure ulcers) were present in more than 70% of hospitals. Level I and II trauma centers had greater adoption of recommendations than level III/IV trauma centers and non-trauma centers. Continued efforts are needed to promote and support the advancement of IOM recommendations throughout U.S. hospitals. PMID:24702716
Maxwell, Cathy A
As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described. PMID:24557516
Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O
SENIOR MEDICAL STUDENT EMERGENCY MEDICINE ROTATION STUDENT MANUAL 2011 Â 2012 #12;GUIDELINES FOR SENIOR MEDICAL STUDENTS Emergency Medicine Rotation Wayne State University@hfhs.org Revised:11/18/10 /waj #12;Senior Medical Student Emergency Medicine Clerkship Clerkship
Advocating vaccination of adults aged 60 years and older in Western Europe: statement by the Joint Vaccine Working Group of the European Union Geriatric Medicine Society and the International Association of Gerontology and Geriatrics-European Region.
Vaccines are an underused public health strategy for healthy aging. Considering the risks of vaccine-preventable diseases and the current low vaccine coverage rates in older European citizens, the two European geriatric and gerontological societies (European Union Geriatric Medicine Society [EUGMS] and International Association of Gerontology and Geriatrics-European Region [IAGG-ER]) convened a Joint Vaccine Working Group to develop a consensus document advocating routine vaccination of aging populations. The mandate of this Working Group was to improve the uptake of routine vaccinations in adults aged 60 years and over. The consensus statement underlines the need to establish, strengthen, and harmonize European policies that continue routine vaccinations to adulthood and that will include older populations. Improved vaccination rates will promote healthy aging by reducing the burden of vaccine-preventable infectious diseases in older populations, a population that is rapidly increasing in Europe. PMID:19415978
Michel, Jean-Pierre; Chidiac, Christian; Grubeck-Loebenstein, Beatrix; Johnson, Robert W; Lambert, Paul Henri; Maggi, Stefania; Moulias, Robert; Nicholson, Karl; Werner, Hans
Background The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care. Aims To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010–2011 Year Three Family Medicine Clerkship rotation curriculum. Methods A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students’ educational experience of using this case. Results Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students’ self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as ‘Good to Excellent’, 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate. Conclusions The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs. PMID:24267774
Tan, Amy; Ross, Shelley Paige; Duerksen, Kimberley
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…
Shield, Renee R.; Farrell, Timothy W.; Nanda, Aman; Campbell, Susan E.; Wetle, Terrie
University of Wisconsin School of Medicine and Public Health Course Title: Extramural Elective may include public health, prevention, and health education activities. Placements will be approved diagnosis and management, epidemiological, public health and prevention aspects of acute and/or chronic
Problems encountered in a psychiatry clerkship when the medical student identifies in various ways with his psychiatric patients are described. The patterns of this identification process and the effects on student-patient interaction are included. The students were enrolled at the University of Illinois School of Medicine. (Author/JMD)
Crawford, James W.; Siomopoulos, V.
Although many professional and accrediting bodies have identified competencies for medical students pertaining to caring for older patients, including understanding the basics of the healthcare delivery system, the highly structured curriculum in medical school provides few opportunities for these competencies to be achieved. One possible solution is to let students participate in geriatrics-related extracurricular educational and clinical activities and ask them to reflect on their experiences. This article presents the results of a qualitative analysis of student reflections from participating in such a program implemented at the University of Cincinnati College of Medicine. One hundred thirty of 321 student journal entries (collected over 3 academic years) containing any mention of the healthcare system were qualitatively analyzed. The themes and resulting model that emerged from the data includes three distinct levels of healthcare delivery: individual, organizational, and systems. Each level is presented and explained using illustrative student quotes. As a whole, the model indicates that students in this innovative extracurricular experience gained important knowledge about how medical care is provided to elderly people. The model developed may provide additional structure for future medical students as they reflect on their early encounters with the complex health and social forces affecting the quality of care received by older adults. PMID:18179485
Goldenhar, Linda M; Margolin, E Gordon; Warshaw, Gregg
Background Older adults often use complementary medicine; however, very few interventional studies have focused on them. The aim of this study was to evaluate the feasibility and to obtain preliminary data on effectiveness of an Integrative Medicine (IM) program compared to usual medical care. Methods The study consisted of older adults living in shared apartment communities including caregiving. The shared apartments were cluster-randomized to the IM program or Usual Care (UC). IM consisted of additional lifestyle modification (exercise and diet), external naturopathic applications, homeopathic treatment, and modification of conventional drug therapy for 12 months. The UC group received conventional care alone. The following outcomes were used: Nurses Observation Scale for Geriatric Patients (NOSGER); Assessment of Motor and Process Skills; Barthel Index; Qualidem; Profile of Wellbeing; and Mini-mental State Examination. Exploratory effect sizes (Cohen’s d, means adjusted for differences of baseline values) were calculated to analyze group differences. Results A total of eight shared apartment communities were included; four were allocated to IM (29 patients, median seven patients; [mean ± standard deviation] 82.7 ± 8.6 years) and four to UC (29 patients, median eight patients; 76.0 ± 12.8 years of age). After 12 months, effect sizes ?0.3 were observed for activities of daily living on the NOSGER-Activities of Daily Living subscale (0.53), Barthel Index (0.30), Qualidem total sum score (0.39), Profile of Wellbeing (0.36), NOSGER-Impaired Social Behavior (0.47), and NOSGER-Depressed Mood subscales (0.40). Smaller or no effects were observed for all other outcomes. The intervention itself was found to be feasible, but elaborate and time consuming. Discussion This exploratory pilot study showed that for a full-scale trial, the outcomes of Activities of Daily Living and Quality of Life seem to be the most promising. The results have to be interpreted with care; larger confirmatory trials are necessary to validate the effects. PMID:23901266
Teut, Michael; Schnabel, Katharina; Baur, Roland; Kerckhoff, Annette; Reese, Frauke; Pilgram, Niels; Berger, Franziska; Luedtke, Rainer; Witt, Claudia M
PEDIATRICS CLERKSHIP REVIEW MEC MEETING, NOVEMBER 2011 (Version 12/14/11) This is a brief summary of the Pediatrics Clerkship discussion at the MEC meeting for the diagnosis and management of common acute and chronic illnesses in the pediatric
Myers, Lawrence C.
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 important contribution to the building of that specialty,
Joanna Bornat; Leroi Henry; Parvati Raghuram
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…
Bornat, Joanna; Henry, Leroi; Raghuram, Parvati
Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center…
Newell, Debra A.; Raji, Mukaila; Lieberman, Steven; Beach, Robert E.
Summary pointsExercise has protective effects: it is associated with decreased disability score and decreased rate of myocardial infarction; it is also effective in very old peopleMultifactorial interventions decrease the likelihood of fallsLow body mass considerably increases the risk of hip fracture in older women; other risk factors include alcohol consumption, prior stroke, low activity levels, use of long acting benzodiazepines,
Rebecca D Elon
Background The article discusses the position of elderly patients in the context of medical intervention. The phenomenon of a “greying” population has changed the attitude towards the elderly but common observations prove that the quality of geriatric care is still unsatisfactory. This is a comparative study of personality among people at different ages, designed to improve specialists’ understanding of ageing. The results are discussed in relation to the elderly patient-centered paradigm to counterbalance ageist practices. Material/Methods This study involved 164 persons in early and late adulthood. Among the old, there were the young old (ages 65–74) and the older old (ages 75+). All participants were asked to fill-out the NEO-FFI . Results The results demonstrate age-related differences in personality. In late adulthood, in comparison to early adulthood, there is decreased openness to new experiences. Two traits – agreeableness and conscientiousness – increase significantly. Age did not differentiate significantly the level of neuroticism or extraversion. The results of cluster analyses show differences in taxonomies of personality traits at different periods of life. Conclusions The results challenge the stereotypes that present older people as neurotic and aggressive. Age did not significantly influence the level of neuroticism or extraversion. In general, the obtained results prove that the ageist assumption that geriatric patients are troublesome is false. This article builds support for effective change in geriatric professional practices and improvement in elderly patients’ quality of life. PMID:23949099
Blachnio, Aleksandra; Bulinski, Leszek
Geriatric education and training are most successful when taught in a setting that provides the medical and social services that elderly persons often require. At Mount Zion Hospital and Medical Center, medical students and trainees participate in several geriatric services that introduce them to the special health needs of the elderly, including the ambulant and the homebound. In the Mount Zion/University of California, San Francisco, geriatric education and training program, we have defined three principles of geriatric medicine that are unique to the field and are best applied directly within the service setting. This setting emphasizes (1) the special body of knowledge regarding aging and health care of the elderly, (2) the importance of assessing functional capacity and (3) the role of the health team. Our experience indicates that when students and trainees observe the application of these principles in a range of geriatric services they begin to understand the complex health problems with which geriatric medicine is concerned. PMID:7336715
Feigenbaum, Lawrence Z.; Allen, Carol L.; Brownstein, Harold
The community-based internist and geriatric primary care physicians (PCPs) or medical doctors (MDs) have long been the most prevalent providers of primary care to populations who have chronic illness and\\/or are elderly in the United States. This article addresses the strategies for disease management (DM) that physicians in nonmature health care markets are utilizing to address unmet needs and suggestions
Maureen Dailey; Geraldine Lanman
Contrary to recommendations from national medical organizations, medical school education often fails to train students to interact effectively with patients with limited health literacy. The objectives of a new health literacy curriculum in a family medicine clerkship were to increase students' knowledge of health literacy and develop comfort with specific communication skills. Instructional strategies included lectures, practice with standardized patients
Donna M. Roberts; Jeri R. Reid; April L. Conner; Sharon Barrer; Karen H. Miller; Craig Ziegler
Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations. PMID:25274536
Liu, Fang; Ranmal, Sejal; Batchelor, Hannah K; Orlu-Gul, Mine; Ernest, Terry B; Thomas, Iwan W; Flanagan, Talia; Tuleu, Catherine
, I would start with surgery. This is the one rotation where you will learn to be efficient and learn (peds, surgery, obgyn, medicine, family) by the end of 3rd year or the following summer. Neurology is not required to do away rotations or to take Step 2 but it is helpful. Acute care/geriatrics is not necessary
An examination of an open-book testing approach in a family medicine clerkship seeks to determine whether this method more closely mirrors the discipline of family medicine, where practitioners refer daily to written resource materials in order to make clinical decisions without compromising the learning and assessment process. Student scores on the multiple-choice test were analysed by year, by quarter and by site using ANOVA. Students in the experimental site were interviewed to determine preparation style, use of text during test, as well as attitudes toward open-book testing. Analysis of variance showed that the interaction of site and year was significant at p = 0.03. The mean score of 88.2 for Maine students in 2002 was significantly different from the other three mean scores. The desired qualitative outcomes of the intervention were confirmed: reducing the anxiety of students, wider reading of the textbook, knowing the structure of the textbook as a learning resource, and deeper understanding of concepts and principles rather than time spent on memorization. While the difference in scores did reach statistical significance, it is important to note that the difference in mean score was only four points on a 100-point scale. Given the percentage of the total grade represented by the test score, it is unlikely that this difference represents any real difference in grade for students in Maine compared with Vermont. The students appeared to approach the textbook and therefore, perhaps, the body of knowledge as a whole with the orientation of a generalist. The MMC Clerkship Director recommended the implementation of the open-book approach to the Family Practice clerkship at all sites and the University of Vermont Medical School accepted the proposal. This recommendation supports advising students on the preparation for an open-book test and on tactics for the best use of the textbook during the test. PMID:16147801
Broyles, India L; Cyr, Peggy R; Korsen, Neil
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…
Blanchette, Patricia Lanoie; And Others
Objective: To assist and inform the process of revising learning objectives for the psychiatry clerkship, a comprehensive review of the current state of learning objectives endorsed by national specialty organizations for core clinical clerkships was undertaken. Methods: National specialty organizations that have developed and endorsed clerkship…
Burke, Michael J.; Brodkey, Amy C.
Objective To determine factors associated with tobacco cessation counseling in medical school clerkships Methods Third-year medical students at 10 medical schools across the United States completed a 100-item survey, measuring the frequency with which they experienced their preceptors’ providing clinical teaching components: clear instruction, feedback, modeling behavior, setting clear objectives, and responding to questions about tobacco dependence counseling as well as frequency of use of tobacco prompts and office systems. Our primary dependent measure was student self-reported skill level for items of tobacco dependence treatment (e.g. “5As”). Results Surveys were completed by 1213 students. For both family medicine and internal medicine clerkships, modeling and providing clear instruction on ways to provide tobacco counseling were reported most commonly. In contrast, providing feedback and clear objectives for tobacco dependence treatment lagged behind. Overall, students who reported preceptors’ provision of optimal clinical teaching components and office system prompts in both family medicine and internal medicine clerkships had higher self-reported skill (p<0.001) than students with no exposure or exposure during only one of the clerkships. Conclusions Future educational interventions intended to help students adopt effective tobacco dependence treatment techniques should be engineered to facilitate these critical precepting components. PMID:23623894
Geller, Alan C.; Hayes, Rashelle B.; Leone, Frank; Churchill, Linda C.; Leung, Katherine; Reed, George; Jolicoeur, Denise; Okuliar, Catherine; Adams, Michael; Murray, David M.; Liu, Qin; Waugh, Jonathan; David, Sean; Ockene, Judith K.
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
Myers, Michael F; Herb, Alice
Surgery Clerkship MID-ROTATION EVALUATION The University of Chicago Division of the Biological evaluate the student's level of skill in the following competencies in Surgery. On the next page, please provide written comments to explain your scores. 0 1 2 3 4 5 Diagnosis and Management in Surgery 1
Describes an elective clerkship rotation in pharmacy education for PharmD students designed to develop their skills and stimulate their interest in the teaching and service aspects of academic life. Student feedback and evaluations of the rotation were very positive. (EV)
Hammer, Dana P.; Paulsen, Susan M.
Background: Team learning, an innovative educational method combining interac- tive small group learning with expert-based content delivery, was introduced into our psychiatry clerkship in 2002. The main goal was to increase classroom engagement and improve educational outcomes. Description: Eight of 16 lectures were replaced with team learning activities, includ- ing prerequisite readings, readiness assurance tests, and application exercises. Data on
Ruth E. Levine; Michael O'Boyle; Paul Haidet; David J. Lynn; Michael M. Stone; Dwight V. Wolf; Freddy A. Paniagua
evaluate the student's level of skill in the following competencies in Neurology. On the next page, pleaseNeurology Clerkship MID-ROTATION EVALUATION The University of Chicago Division of the Biological provide written comments to explain your scores. 0 1 2 3 4 5 Diagnosis and Management in Neurology 1
This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively
Barbara Carrick Andrews; Judy Kaye; Marilyn Bowcutt; Joseph Campbell
Career development is rarely formalized in the curricula of geriatric fellowship programs, and the training of new generations of academic leaders is challenging in the 1 year of fellowship training. To effectively prepare fellows for academic leadership, the University of Rochester's Division of Geriatrics, in collaboration with the Warner School of Graduate Education, created a yearlong course to achieve excellence in teaching and career development during the 1-year geriatric fellowship. Nine interdisciplinary geriatric medicine, dentistry, and psychiatry fellows completed the course in its initial year (2005/06). As participants, fellows gained the knowledge and experience to successfully develop and implement educational initiatives in various formats. Fellows acquired teaching and leadership skills necessary to succeed as clinician-educators in an academic setting and to communicate effectively with patients, families, and colleagues. Fellows completed a series of individual and group education projects, including academic portfolio development, curriculum vitae revision, abstract submission and poster presentation at national meetings, lay lecture series development, and geriatric grand rounds presentation. One hundred percent of fellows reported that the course positively affected their career development, with six of nine fellows choosing academic careers. The course provided opportunities to teach and assess all six of the Accreditation Council of Graduate Medical Education core competencies. This academic career development course was intended to prepare geriatric fellows as the next generation of academic leaders as clinician-teacher-scholars. It could set a new standard for academic development during fellowship training and provide a model for national dissemination in other geriatric and subspecialty fellowship programs. PMID:17971139
Medina-Walpole, Annette; Fonzi, Judith; Katz, Paul R
Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. PMID:24721360
Kates, Stephen L
to HHD Intro to HHD Nervous System Human Health & Disease: Pulmonary Cardiovascular Human Health-16 Â· Applied Biochemistry Â· Genetics Â· Developmental Biology Â· Basic Cardiac Life Support Nervous System Intro of Medicine Anatomy Nervous System Practice of Medicine Practice of Medicine Practice of Medicine 2:15 3
Medical student instructional costs were determined for a required third-year primary care clerkship based in an ambulatory care setting. Included in the analysis were labor costs of faculty and other personnel, space, materials, and university overhead. Implications of the high costs generated by such clerkships are discussed. (Author/JMD)
And Others; Pawlson, L. Gregory
Background In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a 'community of practice' with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages. Methods Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis. Results The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors' commitment to their profession, 'handing on' to the next generation and helping their community to attract doctors in the future. Conclusions Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution. PMID:21951836
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,…
Stine, Curtis; Kohrs, Francis P.; Little, David N.; Kaprielian, Victoria; Gatipon, Betty B.; Haq, Cynthia
. Description of clerkship (Todd Poret) 1a. Faculty status of teachers at all sites. Students selecting Peds as a career choice 2008-11 8. Specific competency tasks Mixture of inpatient and outpatient experiences #12;1a. Faculty Status of Teachers
Myers, Lawrence C.
... providers, educating the community, and advocating for public health care policy are just a few of the ways in which geriatric psychiatrists support their patients. The geriatric psychiatrist is a ... Mental Health Foundation. All rights reserved. Legal Notice and Disclaimer · ...
In order to develop strategies for raising the interest of medical students in a career in elderly care medicine (a specialty in The Netherlands) we should start by gaining more insight into the process influencing career choices among medical students and graduates. In this qualitative study we conducted three focus group discussions with trainees in elderly care medicine and two focus group discussions with obstetrics and gynaecology trainees. We found that all trainees made their career choice after clinical exposure in the field. The elderly care medicine trainees did not make their choice until after graduation, working in temporary employment in a nursing home. The obstetrics and gynaecology trainees made their specialty choice during medical school after their clerkship. Almost all focus group participants had a very negative perception during medical school about geriatrics and elderly care medicine. Once they were employed in a nursing home they changed their minds. They came to realize the work was more interesting, more difficult, more intensive and more meaningful than they had initially thought. PMID:24399288
Meiboom, A A; de Vries, H; Hesselink, B A M; Hertogh, C M P M; Scheele, F
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…
Schigelone, Amy Schiller; Ingersoll-Dayton, Berit
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…
Schigelone, Amy Schiller; Ingersoll-Dayton, Berit
This article describes a geriatric collaborative practice model in which primary care physicians (family practice and internal medicine) and nurse case managers are key members of a multidisciplinary team providing care to elderly rural patients in east central Illinois. Client characteristics, nursing case management roles, and the strengths and benefits associated with this geriatric collaborative model are presented. PMID:7735081
Shelton, P; Schraeder, C; Britt, T; Kirby, R
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…
Woolsey, Lisa J.
The geriatric population (age 65 and older) is the fastest growing segment nationally and globally. The large population will continue to increase because of baby boomers that have recently turned 65 years old. Within this cohort, there is much diversity in health, socioeconomic levels, education, and health beliefs. There is a decline in edentulism yet still there are oral health conditions that persist with age, such as caries, tooth loss, and increased needs for prosthodontic dental treatment. Several factors should be taken into account in geriatric prosthodontic care, including quality of life and psychosocial needs. PMID:24286648
Partida, Mary Norma
Today'sDate: / / University of Tennessee - College of Medicine Department Of Family Medicine M3 Course Structure: Family Medicine Clerkship rotation consists of two required core educational blocks (4 weeks each). For the most part students will be assigned to one of the UT Family Medicine residency
Background: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question.Methods: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were
Dan Poenaru; Lindsay Davidson; Michael Donnely
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…
Shah, Uday; Aung, Myo; Chan, Susanna; Wolfklein, Gisele
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
Emami, Morteza; Nazarinia, Mohammad Ali; Rezaeizadeh, Hussein; Zarshenas, Mohammad M
Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns. PMID:16551323
Maurer, Mathew S; Costley, Alex W; Miller, Patricia A; McCabe, Sigrid; Dubin, Shelly; Cheng, Huai; Varela-Burstein, Ellyn; Lam, Binh; Irvine, Craig; Page, Kerrianne P; Ridge, Gerald; Gurland, Barry
Background Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups. Materials and Methods Consecutive geriatric patients (?65 years old) visiting the emergency department (ED) of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ?37.2°C or a baseline temperature elevated ?1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done. Results Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3), Severe coma (GCS ? 8), and Thrombocytopenia (platelets <150 103/mm3) (LST). After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0%) (95% CI: 2.3–6.9%): a general ward or treatment in the ED then discharge and high (30.3%) (95% CI: 17.4–47.3%): consider the intensive care unit. The area under the curve for the rule was 0.73. Conclusions We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need. PMID:25340811
Vong, Si-Chon; Yang, Tzu-Meng; Chen, Kuo-Tai; Lin, Hung-Jung; Chen, Jiann-Hwa; Su, Shih-Bin; Guo, How-Ran; Hsu, Chien-Chin
Developed by the University of Minnesota's Hartford Center of Geriatric Nursing Excellence, these resources are designed to assist nursing students in their quest to become effective health care providers to older adults. After reading a brief introduction to the site, visitors can use the table of contents to find the materials that will be most useful to them. Here they will find a listing of over 40 topic areas, including Biology of Aging, Depression, and Oral Health. Most areas contain at least a dozen links, complete with brief descriptions of the resources and how they might be used in practice or in an educational setting. Finally, visitors can sign up to receive updates when new materials are posted to the site.
existed for development of a PEM student curriculum. Thestudent level, and continue throughout training and practice. classification/diagnostic criteria and guideline development.development of a curriculum and followed the National Institute of Health guidelines for consensus building to determine the appropriate student
A study investigated the effectiveness of computer-assisted instruction, interactive video, and videotapes as alternative methods of instruction in clinical clerkship modules on diabetes and hypertension. The 17 participants were more interested in balancing time between patient contact and alternative teaching methods and had better knowledge,…
Berman, Judith; And Others
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…
West, Donald A.; Nierenberg, David W.
Most veterinarians hold a 'pediatric' rather than 'garage mechanic' view of their function. In recent years, sophisticated medical modalities have allowed veterinarians to keep animals alive, and increased value of companion animals in society has increased demand for such treatment. But whereas humans can choose to trade current suffering for extended life, animals seem to lack the cognitive apparatus required
Bernard E. Rollin
Background: The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. Objective: The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique
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
Objective: Since April 1, 2008, patients aged ?65 years presenting with a hip fracture at Ziekenhuisgroep Twente, Almelo (ZGT-A), The Netherlands, have been admitted to the geriatric fracture center (GFC) and treated according to the multidisciplinary treatment approach. The objective of this study was to evaluate how implementation of the treatment approach has influenced the quality of care given to older patients with hip fracture. Design: Prospective cohort study with historical control group. Method: Two groups of patients with hip fracture were compared, 1 group was treated according to the new multidisciplinary treatment approach in 2009-2010, and the other group received the usual treatment in 2007-2008. The number of readmissions within 30 days after discharge was compared, and an analysis was carried out regarding the number of complications, the number of consultations with various specialists and with the geriatrician, and the duration of hospital stay. Results: In all, 140 patients from 2009 to 2010 group and 90 patients from 2007 to 2008 group were included. In 2009-2010 group, the number of readmissions within 30 days dropped by 11 percentage points (P = .001). The incidence of the number of complications decreased with a median of 1 compared with 2007-2008 (P = .017) group. Delirium was diagnosed to be 6 percentage points more frequent. The median number of consultations with various specialists per patient decreased by 1 percentage point as a result of geriatrician cotreatment (P = .002). The median duration of hospital stay was 1 day shorter than that in 2007-2008 group. Conclusion: The use of the multidisciplinary treatment approach led to a significant reduction in the number of readmissions within 30 days after discharge. It appears to be associated with improved short-term treatment outcomes for older patients with a hip fracture. PMID:23569698
Folbert, E. C. Ellis; Smit, Ruth S.; van der Velde, Detlef; Regtuijt, E. M. Marlies; Klaren, M. Hester; Hegeman, J. H. Han
The Department of Community Health and Family Medicine at the University of Florida College of Medicine developed a curriculum component integrating epidemiologic concepts into a third year family medicine clerkship through a small-group project on a specific condition likely to be encountered by primary care physicians in community practice. (MSE)
Duerson, Margaret C.; And Others
of the third-year family medicine clerkship. Today, this curriculum remains the only one of its kind at a U the development of a shared decision-making curriculum. Cathleen Morrow, M.D., the director of the family medicine that teaching these shared decision-making skills in parallel with the core curriculum in family medicine
Myers, Lawrence C.
Objectives: We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship. Methods: We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores. Results: Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r = 0.347, p < 0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R2? = 0.131, p < 0.001) and of better faculty clinical scores (R2? = 0.078, p < 0.001). Conclusions: Student assessment by an OSCE provides a reliable and predictive objective assessment of clinical performance in a neurology clerkship. PMID:22855865
Adesoye, Taiwo; Smith, Sandy; Blood, Angela; Brorson, James R.
A B S T R A C T Objectives: The preclinical years of undergraduate medical education provide educational content in a structured learning environment whereas clerkships provide clinical training in a more experiential manner. Although early clinical skills training is emphasized in many medical schools, students still feel unprepared and anxious about starting their clerkships. This study identifies the skills
RM Small; RP Soriano; M Chietero; J Quintana; V Parkas; J Koestler
The emphasis on a generalist professional education has led to shortening and restructuring of the surgery clerkship in the curricula of many medical schools. Little data exist regarding the effect of these changes on student performance. Therefore, we examined the effect of the length, timing, and content of the third year surgery rotation on several clerkship and postclerkship performance measures
D. Scott Lind; Tiffany Marum; Daniel Ledbetter; Timothy C. Flynn; Lynn J. Romrell; Edward M. Copeland
Objectives: To investigate how the pediatric clerkship affected student attitudes toward pediatrics, and to de- termine if correlations existed between changes in atti- tudes toward pediatrics and in ratings of certain aspects of the clerkship with an increased interest in a pediatric career. Methods: A one-page survey measuring interest in a career in pediatrics and agreement or disagreement with seven
Paul B. Kaplowitz; Russell Boyle; Jiandong Lu
Objective: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. Methods: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject…
Niedermier, Julie; Way, David; Kasick, David; Kuperschmidt, Rada
Objective: The goal of this study was to evaluate a recent medical school curriculum change at our institution 3 years ago; specifically: shortening the Psychiatry core clerkship from 4 to 3 weeks and adding an optional 6-week core/elective combination rotation in lieu of the 3-week core. The authors aimed to determine whether clerkship length was…
Bostwick, J. Michael; Alexander, Cara
This document is a curriculum guide for a one semester course in geriatrics designed to be taught in high schools in Connecticut. Following introductory material about course philosophy and objectives, and a course outline, the guide contains nine units. Each unit consists of some or all of the following items: time allotment, overview, outline of…
Manchester Board of Education, CT.
In 1965, the federal government passed the Older Americans Act (OAA) and the Administration on Aging (AoA) was created. By that act, older Americans were considered to be persons 60 years of age or older. There are many terms used to define this population of individuals, including geriatric, senior, seasoned, and aged. This chapter uses these terms interchangeably. From a
James D. Helsley; Sandra K. Vanin
The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 20301. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people
Jayant M Pinto; Seema Jeswani
Contends that the diagnosis of depression in aged patients is the responsibility of both psychologists, and non-psychologists, for it is the latter that is most likely to make initial contact with an elder in need of help. Describes problems in the use of psychometric tests to identify geriatric depression. Reviews the advantages and disadvantages and limitations of scales currently employed.
T. L. Brink; Jerome A. Yesavage; Owen Lum; Philip H. Heersema; Michael Adey; Terrence L. Rose
The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators…
Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.
.D. (DH) David Jacobson, M.D. (CPMC) Holly Harrison 7500 Fax- 653-3519 653-3554 Medicine (Outpatient) Mary Beth Durkin, MD Roshini Pinto-Powell, MD Holly Harrison 7500 653-3519 Neurology Justin J. Mowchun Hanissian, MD Lori L. Avery 7420 Fax 653-9295 650-0906 Pediatrics Adam Weinstein, MD Alison Holmes, MD
Myers, Lawrence C.
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 clerkship model and then evaluate the impact of this on performance on clerkship summative evaluations. We followed Kern's framework to design our curriculum and then compared performance on the clerkship objective structured clinical examination (OSCE), all summative clerkship multiple choice question (MCQ) examinations, and the Medical Council of Canada Qualifying Examination (MCCQE) Part 1 before and after the introduction of our curriculum. In the 2 years following the introduction of our clinical skills curriculum the mean score on the clerkship OSCE was significantly higher than in the 2 years prior to our curriculum [67.12 (5.3) vs. 62.44 (4.93), p < 0.001, d = 0.91]. With the exception of the surgical clerkship MCQ, performance on all clerkship summative MCQ examinations and MCCQE Part 1 was significantly higher following the introduction of our curriculum. In this study we found a significant improvement in the performance on clerks on summative evaluations of knowledge and clinical skills following the introduction of our clinical skills curriculum. Given the unpredictable nature of clinical rotations, the clerkship will always be a risk of failing to deliver the intended curriculum-so medical schools should continue to explore and evaluate ways of changing the delivery of clerkship training to improve learning outcomes. PMID:24510325
Veale, Pamela; Carson, Julie; Coderre, Sylvain; Woloschuk, Wayne; Wright, Bruce; McLaughlin, Kevin
Objective To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. Study Design Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students’ baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. Results Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, ? 2=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, ? 2=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. Conclusion Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored. PMID:24300748
Craig, LaTasha B.; Smith, Chad; Crow, Sheila M.; Driver, Whitney; Wallace, Michelle; Thompson, Britta M.
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)
Mouton, Charles P.; Parker, Robert W.
Primary care settings present important opportunities for the detection and management of depression in older adults. As many as 10 % of older adults presenting in primary care have clinically significant depression, but only about half are recognized and only one in five depressed older adults receive effective treatment in primary care. We review common barriers to effective treatment such as atypical clinical presentations and comorbid medical conditions that are common in older adults. We identify treatment strategies such as measurement-based stepped care and collaborative care that can substantially improve the effectiveness of treatment in this setting and we highlight opportunities for addressing health disparities in geriatric depression care. We also point out the importance of engaging and supporting family caregivers of depressed older adults. We conclude by identifying three strategic areas to improve the treatment of geriatric depression in primary care: activation and engagement of patients and family members, health care provider training, and broader system changes. PMID:21536169
Park, Mijung; Unutzer, Jurgen
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. 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
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…
Fitzgerald, James T.; Williams, Brent C.; Halter, Jeffrey B.; Remington, Tami L.; Foulk, Mariko A.; Persky, Neal W.; Shay, Barbara R.
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
Guarino, Salvatore; Di Matteo, Filippo; Sorrenti, Salvatore; Greco, Roberto; Nardi, Matteo; Favoriti, Pasqualino; De Antoni, Enrico; Filippini, Angelo; Catania, Antonio
Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups. PMID:24738753
A study of the influence of clinical experiences on one medical school's students' choice of specialty found that neither early exposure to role models in family medicine nor the order in which specialty clerkships were taken significantly affected students' choice of family medicine. (MSE)
Allen, Sharon S.; And Others
Describes a collaboration to analyze and integrate elements of women's health into the core curriculum in internal medicine for a medical school's third year clerkship. Illustrates the new curriculum by describing the new module in pulmonary medicine and discusses the use of the process to integrate curricula in other interdisciplinary fields.…
Nicolette, JoDean; Jacobs, Michael D.
Geriatrician Clinician-Educator The Division of Hospital Medicine and Division of General Internal Medicine & Geriatrics within the Department of Medicine at Oregon Health & Science University seek to an academic career. This position will be a joint appointment in the Divisions of Hospital Medicine
Chapman, Michael S.
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
Hazzard, W R
Abstract Hyperthyroidism and chronic renal disease occur commonly in geriatric cats, often in association with potentially life-threatening primary or secondary hypertension. Early treatment of hypertension minimizes damage to vital organs. This case illustrates the complexity of managing hypertension in a geriatric cat with both hyperthyroidism and renal disease. PMID:15206594
Falls are common among the elderly patients in the psycho-geriatric wards and yet they have been understudied. A fall is a multi-factorial syndrome involving the patient and the environment. Psycho- geriatric patients who fall may suffer serious physical injuries that result in morbidity, further institu- tionalisation or even mortality. This study aims to examine the contributing factors to, and morbidity
K D Lim; K C Ng; S K Ng; L L Ng
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 ? 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
Williams, Brent C; Fitzgerald, James T
This article seeks to raise awareness of workforce issues among geriatricians in caring for the increasing number of older Americans with disabilities who will need long-term care. Using a snowball sampling technique, telephone or in-person interviews were conducted with 10 geriatricians to obtain providers' perspectives of the challenges of having an adequate supply of qualified physicians working in Texas nursing homes. Speaking from experience (these geriatricians had an average of 15 years of work experience in nursing homes), the geriatric experts reflected upon reasons for choosing (or not) geriatric medicine; reasons for choosing (or not) to work in nursing homes; and the status of geriatrics in the United States. To meet the increasing demand for nursing home services, the findings of this article suggest strengthening support for the geriatrician workforce. Specific recommendations for training the next generation of geriatricians are presented. PMID:24138181
Lee, Wei-Chen; Dooley, Kim E; Ory, Marcia G; Sumaya, Ciro V
Demographic changes in our society will lead to an increasing proportion of elderly people. Age-associated multimorbidity often results in polypharmacy and elevates the risk of adverse drug reactions. Decisive alterations in pharmacokinetics and pharmacodynamics are detectable in old age, primarily a decrease in total body water, an altered ratio of muscle mass to fatty tissue, and decreased renal function. Changes in gastrointestinal transit, plasma protein binding, hepatic drug metabolism, and an increased susceptibility to drug-induced cognitive decompensation have also been reported. All these alterations should be considered in geriatric dermatotherapy to minimize drug-related complications caused by over- or underdosage and drug interactions. PMID:24916756
Kratzsch, Dorothea; Treudler, Regina
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…
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.
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.
Cole, Leonard A.; Wagner, Katherine; Scott, Sandra; Connell, Nancy D.; Cooper, Arthur; Kennedy, Cheryl Ann; Natal, Brenda; Lamba, Sangeeta
Background Skills lab training has become a widespread tool in medical education, and nowadays, skills labs are ubiquitous among medical faculties across the world. An increasingly prevalent didactic approach in skills lab teaching is peer-assisted learning (PAL), which has been shown to be not only effective, but can be considered to be on a par with faculty staff-led training. The aim of the study is to determine whether voluntary preclinical skills teaching by peer tutors is a feasible method for preparing medical students for effective workplace learning in clerkships and to investigate both tutees’ and tutors’ attitudes towards such an intervention. Methods A voluntary clerkship preparation skills course was designed and delivered. N?=?135 pre-clinical medical students visited the training sessions. N?=?10 tutors were trained as skills-lab peer tutors. Voluntary clerkship preparation skills courses as well as tutor training were evaluated by acceptance ratings and pre-post self-assessment ratings. Furthermore, qualitative analyses of skills lab tutors’ attitudes towards the course were conducted following principles of grounded theory. Results Results show that a voluntary clerkship preparation skills course is in high demand, is highly accepted and leads to significant changes in self-assessment ratings. Regarding qualitative analysis of tutor statements, clerkship preparation skills courses were considered to be a helpful and necessary asset to preclinical medical education, which benefits from the tutors’ own clerkship experiences and a high standardization of training. Tutor training is also highly accepted and regarded as an indispensable tool for peer tutors. Conclusions Our study shows that the demand for voluntary competence-oriented clerkship preparation is high, and a peer tutor-led skills course as well as tutor training is well accepted. The focused didactic approach for tutor training is perceived to be effective in preparing tutors for their teaching activity in this context. A prospective study design would be needed to substantiate the results objectively and confirm the effectiveness. PMID:24708782
A new vaccine reduces the incidence and severity of zoster and its complications in older persons. A cost-effectiveness analysis highlights the implication of CDC's recent recommendation to vaccinate all persons aged 60 years and over. A meta-analysis confirms that the chronic use of sedatives in older persons provides modest benefits and important risks. Unfortunately, melatonin does not seem to be a useful alternative. A systematic review of interventions to prevent pressure ulcers provides scientific support to measures empirically used in most institutions. Finally, a randomized controlled trial questions the clinical benefit of atypical neuroleptics in Alzheimer's disease and a comprehensive review of pharmacological trials in mild cognitive impairment reports no benefit of any of the tested drugs on conversion rate to Alzheimer's disease. PMID:17354654
Büla, C; Gold, G
This study focuses on patterns of consensus between linked samples (focal person and confidant; total n = 124) for the purpose of explaining divergent reports and of assessing this design's utility in geriatric case assessment. Correlations, difference scores and group contrasts suggest that elderly informants who are also confidants can describe most internal states of their partners as these states are self-reported. Partners differed however, on ratings of self-esteem; confidant scores were significantly higher than self-ratings. Under certain conditions self-other discrepancy also occurs on spouse ratings of functional health: in early stages of decline and in marriages judged by clinicians to be of poor quality. This pattern is absent in pairs with women friends. The findings suggest that losses and age-related limitations have the potential to erode the self-esteem of older people and that linked samples would strengthen the process of functional assessment by bringing special information to the clinician. PMID:3453281
Clipp, E C; Elder, G H
Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. Older people are predisposed to developing hypernatremia because of age-related physiologic changes such as decreased thirst drive, impaired urinary concentrating ability, and reduced total body water. Medications may exacerbate this predisposition. Hypernatremia and dehydration occurring in nursing homes are considered indicators of neglect that warrant reporting, but there are other nonavoidable causes of hypernatremia, and consideration at time of presentation is essential to prevent delay in diagnosis and management. We describe a case illustrating the importance of the consideration of alternate explanations for hypernatremia in a nursing home resident, followed by a review of hypernatremia in the elderly population, to underscore that neglect is the etiology of exclusion after alternatives have been considered.
Shah, Maulin K; Workeneh, Biruh; Taffet, George E
Merck and Co., Inc., publisher of the standard medical text The Merck Manual of Diagnosis and Therapy (described in the July 19, 1996 Scout Report but no longer available in an Internet version), has placed online the full text of another of its publications, The Merck Manual of Geriatrics. The Manual focuses on the medical problems and care of the elderly and is directed at healthcare professionals, but many older users and those caring for elderly relatives may find it useful. Divided into five sections and 114 chapters, the Manual offers a comprehensive review of the medical, social, psychological, and ethical issues involved in elder healthcare. Sample topics include nutrition, sleep disorders, pharmacology, organ system disorders, sexuality, psychiatric disorders, legal issues, and health insurance, among many others. The entire publication is searchable, and a guide for readers of the online version is provided.
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
Leng, Sean X; Tian, Xinping; Liu, Xiaohong; Lazarus, Gerald; Bellantoni, Michele; Greenough, William; Fried, Linda P; Shen, Ti; Durso, Samuel C
Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers consider the same competencies important for clerkship grading, a survey that consisted of 21 different student characteristics was administered to clinical teachers. Two independent factor analyses using structural equation modeling were conducted to abstract underlying latent relationships among the different student characteristics and to define a clinical competence profile for daily performance of students on the wards and clerkship grading. Differences between the degree of importance for student daily ward performance and clerkship grading are considered and discussed. The results of the survey indicate that the degree of importance of competencies are rated different for daily performance of students on the wards and clerkship grades. Competencies related to the diagnostic process are more important for clerkship grading, whereas interpersonal skills, professional qualities, and motivation are more important for daily ward performance. It is concluded that the components of clinical competence considered important for adequate performance are not necessarily in alignment with what is required for grading. Future research should focus on an explanation why clinical educators think differently about the importance of competencies for student examination in contrast to what is required for adequate daily performance on the wards. PMID:17690992
Wimmers, Paul F; Kanter, Steven L; Splinter, Ted A W; Schmidt, Henk G
OBJECTIVE--To compare postoperative collaborative care between orthopaedic surgeons and physicians in geriatric medicine with routine orthopaedic care in elderly women with proximal femoral fracture. DESIGN--Exclusion of patients dying before fit enough to enter trial, those with pathological fractures, those likely to be discharged within seven days of entering the trial, and those remaining unfit for transfer to a peripheral hospital.
D. C. Kennie; J. Reid; I. R. Richardson; A. A. Kiamari; C. Kelt
Psychometric aspects of multiple-choice tests were investigated using a confidence-weighted scoring technique. The contributions of two indices, overconfidence and underconfidence, in the prediction of subsequent academic performance of examinees were studied. A total of 444 sophomore students (entering classes of 1982 and 1983) in one medical school were asked to indicate their confidence, on a 5-point scale (100, 75, 50, 25, and 0), in the correctness of their responses to each multiple-choice item on an Introduction to Clinical Medicine examination. Examinations were scored in two ways: in the conventional way, using the total number of correct responses, and by a confidence-weighted technique based on the level of certainty indicated for each response by the examinee. Only the conventional score determined the grade; the confidence-weighted score was calculated for the purely experimental purposes of this study. Overconfidence and underconfidence indices were also calculated by using the indicated levels of certainty. Improvements in the psychometrics of the examinations were observed when confidence-weighted scoring was used. In multiple-regression models, the confidence-weighted scores and indices of over- and underconfidence contributed significantly to predicting scores of the students studied on Parts I and II of the National Board of Medical Examiners examinations, whereas the conventional score did not contribute to the prediction of Part II scores. Significant differences on junior clerkship examinations and ratings were observed between those who were highly overconfident and those who were slightly overconfident. The highly overconfident students also estimated higher future incomes than did those who were slightly overconfident. PMID:3199416
Zeleznik, C; Hojat, M; Goepp, C E; Amadio, P; Kowlessar, O D; Borenstein, B
Background and Objectives: Medical education experts have called for improved training in evidence- based medicine (EBM) and the increased use of e-learning technologies in medical education. In re- sponse, we developed an interactive, Web-based curriculum on key aspects of EBM in family medicine. Methods: Students participating in a 6-week family medicine clerkship (n=238) were randomly assigned to intervention (n=134) or
Katherine Schilling; John Wiecha; Deepika Polineni; Souad Khalil
Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less-popular subjects, but the durability of improvements resulting from these resource-intensive learning approaches remains unclear. In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3-hour didactic lecture or 3-hour experiential learning session. Approximately 1 year later, students completed a follow-up knowledge and attitudes survey that was matched to their first-year surveys using date-of-birth data. Of 100 completed follow-up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1-year follow-up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention. This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session. PMID:16686885
Diachun, Laura L; Dumbrell, Andrea C; Byrne, Kerry; Esbaugh, Jacquelin
Medical education shaped by the learning sciences can better serve medical students, residents, faculty, health care institutions, and patients. With increasing innovation in undergraduate and graduate medical education and more focused attention on educational principles and how people learn, this era of educational transformation offers promise. Principles manifest in "educational continuity" are informing changes in educational structures and venues and are enriching new discourse in educational pedagogy, assessment, and scholarship. The articles by Myhre and colleagues and Woloschuk and colleagues in this issue, along with mounting evidence preceding these works, should reassure that principle-driven innovation in medical education is not only possible but can be achieved safely. In this commentary, the authors draw from these works and the wider literature on longitudinal integrated educational design. They suggest that the confluences of movements for longitudinal integrated clerkships and entrustable professional activities open new possibilities for other educational and practice advancements in quality and safety. With the advent of competency-based education, explicit milestones, and improved assessment regimens, overseers will increasingly evaluate students, trainees, and other learners on their ability rather than relying solely on time spent in an activity. The authors suggest that, for such oversight to have the most value, assessors and learners need adequate oversight time, and redesign of educational models will serve this operational imperative. As education leaders are reassessing old medical school and training models, rotational blocks, and other barriers to progress, the authors explore the dynamic interplay between longitudinal integrated learning models and entrustment. PMID:24362396
Hirsh, David A; Holmboe, Eric S; ten Cate, Olle
OBJECTIVE: To describe the history, objectives, statistics, and initiatives used to address challenges associated with the Mayo Clinic Visiting Medical Student (VMS) Clerkship Program. MATERIALS AND METHODS: Mayo Clinic administrative records were reviewed for calendar years 1995 through 2008 to determine the effect of interventions to increase the numbers of appropriately qualified international VMSs and underrepresented minority VMSs. For numerical data, descriptive statistics were used; for comparisons, ?2 tests were performed. RESULTS: During the specified period, 4908 VMSs participated in the Mayo VMS Program (yearly mean [SD], 351 ). 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
Mueller, Paul S.; McConahey, Linda L.; Orvidas, Laura J.; Jenkins, Sarah M.; Kasten, Mary J.
Background No published reports of studies have provided aggregate data on visiting medical student (VMS) programs at allopathic medical schools. Methods During 2006, a paper survey was mailed to all 129 allopathic medical schools in the United States and Puerto Rico using a list obtained from the Association of American Medical Colleges. Contents of the survey items were based on existing literature and expert opinion and addressed various topics related to VMS programs, including organizational aspects, program objectives, and practical issues. Responses to the survey items were yes-or-no, multiple-choice, fill-in-the-blank, and free-text responses. Data related to the survey responses were summarized using descriptive statistics. Results Representatives of 76 schools (59%) responded to the survey. Of these, 73 (96%) reported their schools had VMS programs. The most common reason for having a VMS program was "recruitment for residency programs" (90%). "Desire to do a residency at our institution" was ranked as the leading reason visiting medical students choose to do electives or clerkships. In descending order, the most popular rotations were in internal medicine, orthopedic surgery, emergency medicine, and pediatrics. All VMS programs allowed fourth-year medical students, and approximately half (58%) allowed international medical students. The most common eligibility requirements were documentation of immunizations (92%), previous clinical experience (85%), and successful completion of United States Medical Licensing Examination Step 1 (51%). Of the programs that required clinical experience, 82% required 33 weeks or more. Most institutions (96%) gave priority for electives and clerkships to their own students over visiting students, and a majority (78%) reported that visiting students were evaluated no differently than their own students. During academic year 2006-2007, the number of new resident physicians who were former visiting medical students ranged widely among the responding institutions (range, 0-76). Conclusions Medical schools' leading reason for having VMS programs is recruitment into residency programs and the most commonly cited reason students participate in these programs is to secure residency positions. However, further research is needed regarding factors that determine the effectiveness of VMS programs in residency program recruitment and the development of more universal standards for VMS eligibility requirements and assessment. PMID:20529301
Current geriatrics workforce projections indicate that clinicians who care for adults will need basic geriatrics knowledge and skills to address the geriatric syndromes and issues that limit functional independence and complicate medical management. This is most evident for the clinicians caring for veterans in the Department of Veterans Affairs…
Clark, Elizabeth; Fitzgerald, James T.; Griffith, Jennifer; Weir, Charlene
Counseling patients in preventive health measures may be considerably more difficult for the clinician than managing acute illnesses. It requires medical knowledge and assiduousness on the part of both patient and physician, facilitative systems, the cooperation of significant others, and longitudinal good communication between all of these persons to facilitate the kind of objective-setting necessary to make preventive medicine work. The spectrum of clinical preventive care for the elderly is considerable, and the breadth of communication competencies required for optimal effectiveness somewhat daunting. All are within the scope of activities of the active clinician, however, given time and reflective experience. In this broad domain, what is most important to elderly patients may not be primary prevention (avoidance of onset of new diseases) but tertiary prevention (avoidance of impaired function from diseases already in existence) and avoidance of iatrogenesis. Ironically, the final acts of geriatric clinical prevention are those designed to assure appropriate end-of-life care. PMID:1576578
McCormick, W C; Inui, T S
Reflective writing techniques such as journaling help provide insights into the process by which medical students are mentored and develop into practicing physicians. The authors sought to analyze medical students' journals regarding their mentored experiences within a new geriatrics curriculum at a U.S. medical school. Thirty preclinical and clinical medical student journalers participated in this project. The authors employed qualitative analytic techniques using an interdisciplinary team process. Three major themes emerged: (a) exposure to clinical mentors challenged medical students' preconceptions regarding older adults and geriatric medicine; (b) students learned new medical knowledge and techniques from observing their mentors; and (c) students provided positive and negative assessments of their mentors. Reflective journaling provides important insights into the process by which medical students draw upon mentored clinical experiences during their training. Such mentorship may be particularly relevant to promoting their interest in geriatrics. PMID:24138182
Farrell, Timothy W; Shield, Renée R; Wetle, Terrie; Nanda, Aman; Campbell, Susan
Due to the demographic changes of the last few decades, there has been a significant increase in the number of osteoporotic fractures. After a fracture, geriatric patients are at particularly high risk for an increase of their functional impairments as well as a loss of independence and quality of life. In spite of the severe medical and socioeconomic consequences of fragility fractures, osteoporotic treatment and prevention are still insufficient. Based on the current literature, the pharmacological and nonpharmacological treatment options as well as new surgical techniques for geriatric patients are reviewed. PMID:22714901
Gosch, M; Kammerlander, C; Pils, K; Lechleitner, M; Benvenuti-Falger, U; Roth, T; Joosten-Gstrein, B; Pietschmann, P
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…
Chibnall, John T.; Blaskiewicz, Robert J.
Finding a clinical attending physician role model is one mechanism that medical students can use to cope with the stress engendered by a clinical clerkship. A survey of medical students at the Medical College of Ohio explores this role modeling process. Relevant literature is related and implications of the attending physician role model are…
Gerber, Lane A.
A comparison of traditional objective measures of student clerkship performance (final examination grade and National Board of Medical Examiners Part II test) and subjective evaluations by attending physicians found that the two methods measure different aspects of performance and had relatively low correlations. (MSE)
Musher, Jeremy S.; And Others
Little attention has been given to structured teaching of applied anatomy to senior medical students in problem-based learning (PBL) medical schools. A course named “Anatomical Principles in Surgical Practice” was introduced at the Arabian Gulf University (AGU) in 2001 for fifth- and sixth-year medical students during their surgical clerkship rotation. The course aims to emphasize, update and integrate applied anatomical
M. F. Abu-Hijleh; M. Chakravarty; Q. Al-Shboul; S. Kassab; H. Hamdy
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
Dornan, Tim; Tan, Naomi; Boshuizen, Henny; Gick, Rachel; Isba, Rachel; Mann, Karen; Scherpbier, Albert; Spencer, John; Timmins, Elizabeth
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…
Burgut, F. Tuna; Polan, H. Jonathan
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…
Retamero, Carolina; Ramchandani, Dilip
It is suggested that the pharmacist can provide a vital information link between parents, teachers, and the family physician in the management and treatment of children with learning disabilities. A course is outlined that integrates a clinical clerkship in the field into the pharmacy curriculum. (MSE)
Gourley, Dick R.; Hill, John W.
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
Inouye, Sharon K.; Studenski, Stephanie; Tinetti, Mary E.; Kuchel, George A.
Substance abuse is a widely identified problem in our society. Alcohol abuse is the most problematic, yet most undertreated. Primary care practitioners often do not screen the geriatric population appropriately for at-risk drinking, so the condition goes undiagnosed. This oversight is complicated by the fact that many manifestations of alcohol abuse do not present themselves until well into the disease
care of older adults in West Virginia by enhancing geriatrics training and competency of our state's health professionals that care for our older citizens. Our mission includes creating a sustainable policy and aging, community based care, managed and long term care, and health care service delivery
Background Given the shortage of human resources and the launching of a new Mental Health Plan, recruitment of psychiatrists is currently a major concern in Portugal, as well as in several other countries. Medical students' attitude toward psychiatry has been pointed as a predictor of recruitment. This study aims to evaluate the medical students' perception of psychiatry before and after a clerkship, and the impact on their intention to pursue psychiatry as a future specialty option. Methods Two self-report questionnaires were administered to all 6th year students in a medical school in Lisbon, before and after a 4-weeks full-time psychiatric clerkship, in order to evaluate attitudes toward psychiatry and intention to follow psychiatry in the future. Statistical analysis included Wilcoxon and Chi-square tests. Results 153 students (60.8% female) filled in both questionnaires (no dropouts). After the clerkship, there was a significant improvement regarding the overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, use of legal powers to hospitalize patients and specific medical school factors. There was also a significant increase of students decided or considering the possibility to take a residency in psychiatry. However, perceptions of low prestige and negative pressure from family and peers regarding a future choice of psychiatry remained unchanged in about one-third of the students. Conclusions The results indicate clearly that the clerkship had a favorable overall impact on the student attitude towards psychiatry, as well as in the number of students considering a future career in psychiatry. Attitudes toward psychiatry seems a promising outcome indicator of the clerkship's quality, but further research is needed in order to assess its reliability as a sound predictor of recruitment. PMID:20678213
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
Varteresian, Taya; Lavretsky, Helen
Background Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. Methods One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. Results Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001). Conclusions In conclusion, performance of the general physical examination was already below expectation at the end of the internal medicine clerkship. Possible causes and suggestions for improvement are discussed. PMID:24712683
Purpose: This evaluation study sought to assess the impact of an evidence-based medicine (EBM) course on students' self-perception of EBM skills, determine their use of EBM skills, and measure their performance in applying EBM skills in a simulated case scenario. Methods: Pre- and post-surveys and skills tests were developed to measure students' attitudes toward and proficiency in EBM skills. Third-year students completed the voluntary survey and skills test at the beginning and completion of a twelve-week clerkship in internal medicine (IM) co-taught by medical and library faculty. Data were analyzed using the Mann-Whitney U test for a two-tailed test. Results: A statistically significant increase was found in the students' self-assessment of skills. Students reported using the journal literature significantly more frequently during the clerkship than before, although textbooks remained their number one resource. A majority of students reported frequent use of EBM skills during the clerkship. Statistically significant improvement in student performance was also found on the posttest, although the level of improvement was more modest than that found on the post-surveys. Conclusion: The introduction of EBM skills to students during a clinical clerkship provides students an opportunity to practice EBM skills and reinforces the use of evidence in making patient-care decisions. PMID:15494754
Dorsch, Josephine L.; Aiyer, Meenakshy K.; Meyer, Lynne E.
Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients. PMID:23728022
Brown, Rebecca T; Kiely, Dan K; Bharel, Monica; Mitchell, Susan L
This document presents the proceedings of a conference on geriatric education. These papers are included: Promoting Healthy Aging: A Leadership Role for Geriatric Education; National Research Priorities in Aging; Aging with a Disability; Recent Advances in Clinical Strategies in Geriatric Education: The Role of the Geriatric Nurse in the Acute…
Gardner, Davis L., Ed.; Hoekelman, Margaret C., Ed.
In 1996 PROJECT: geriatric outpatient clinic was initiated by the Ministry of Health and Social Affairs. The purpose was to collect more extensive information about geriatric outpatient clinics in Norway with regard to organization of the clinics, the types of activities and the clinics and the patients attending them. Information on the activities in 1995 was collected, and a summary prepared. Detailed records were made of the activities at 15 geriatric outpatient clinics during March 1996: 288 initial contacts and 239 repeat contacts were recorded. Assessment for mental impairment and multimorbidity constituted 41% of the referrals. The average number og patients per opening hour was rather low: 0.7 (range 0.08-2.5). The pay-back for the hospital was low and there was little incentive to operate the clinics. PMID:9417690
Nygaard, H A; Rø, O C
Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs. PMID:21227518
Karabulut, Hayriye; Baysal, Selcan; Acar, Baran; Babademez, Mehmet Ali; Karasen, Riza Murat
This study explored the convergent and discriminant validity of the Geriatric Anxiety Scale (GAS), a new measure of anxiety symptoms for older adults. The GAS, Beck Anxiety Inventory (BAI), Geriatric Anxiety Inventory (GAI), Beck Depression Inventory, Second Edition (BDI-II), and Geriatric Depression Scale (GDS) were administered to 117 community-dwelling, predominantly White, older adults (62% female; M age = 74.75 years,
Brian P. Yochim; Anne E. Mueller; Andrea June; Daniel L. Segal
that explores the effects of acute alcohol intoxication on the innate immune response to bacterial infection and the increased prevalence of systemic bacterial infections in alcohol abusing hosts. The research may help diabetic kidney. Pharmacological targeting of these serine protease- dependent pathways may provide further
Background Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships. Objective To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice. Methods We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used ?2 analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career. Results Eighty-one students (N ?=? 91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P < .0001) and that the students were treated as part of a team (P ?=? .008). Having clear expectations on labor and delivery procedures (P ?=? .014) was associated with postclerkship career interest. Specific hands-on experiences were not statistically associated with postclerkship career interest. However, performing more speculum examinations in the operating room trended toward having some influence (P ?=? .068). Although more women than men were interested in obstetrics and gynecology as a career both before (P ?=? .027) and after (P ?=? .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P ?=? .024). Conclusions Clerkship factors associated with greater postclerkship interest include higher satisfaction with resident professional behavior and students' sense of inclusion in the clinical team. Obstetrics and gynecology programs need to emphasize to residents their role as educators and professional role models for medical students. PMID:21976080
Chang, Judy C.; Odrobina, Michele R.; McIntyre-Seltman, Kathleen
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
Konkin, Jill; Suddards, Carol
We have previously reported the efficacy of the Patient Oriented Clerkship (POC) in the clinical clerkship in Showa University Hospitals, by a trial with old four-year pharmacy program students. In the unique clerkship, each student has a patient in charge, and follows his/her clinical conditions throughout the rotation. The aim of the POC is that having the students learn spontaneously (Active Learning) and actively (Adult Learning) promoted by student's commitment and responsibility by communicating with patients and health professionals in a team. As the POC requires students both Active Learning and Adult Learning, we define the POC as Active Adult Learning (AAL). Having a patient in charge for each student gives them many opportunities to participate in the medical team and foster their problem solving skills. Our previous study eventually showed positive results of the POC in the one-month short clerkship in the four-year program. On the other hand, the effect of the unique hospital clerkship in the new six-year program is not known. We conducted a student survey to clarify the learning effect in the new six-year education system which was revised and 2.5 month clinical clerkship was scheduled according to the model core clerkship curriculum. This report is the first report to show a challenge of the AAL/POC clerkship in the new six-year pharmacy education program. PMID:22041698
Saito, Isao; Kogo, Mari; Kobayashi, Aya; Watanabe, Toru; Abe, Seiji; Fuke, Shunya; Wakabayashi, Hitomi; Miyano, Masahiro; Karasawa, Koji; Ohto, Yuji; Okazaki, Keinosuke; Hoshi, Akane; Ohtaki, Yumi; Heito, Akira; Tanaka, Hiroki; Fujiwara, Hisato; Yagi, Hitoshi; Ichikura, Daisuke; Ishii, Ayako; Yamada, Kyohei; Sugisawa, Satoshi; Kato, Yukihisa; Murayama, Jun-Ichiro
OBJECTIVES: To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. DESIGN: Secondary analysis of a 3-month randomized, controlled trial of a specialized mobile geriatric assessment team. SETTING: Rural Nova Scotia. Participants were seen in their homes. PARTICIPANTS: Frail older adults, of
David M. Jones; Xiaowei Song; Kenneth Rockwood
An analysis of policy implementation by the Geriatric Education Centers (GEC) program is presented, using a model developed by Sabatier and Mazmanian (1980). A policy by the Bureau of Health Professions to expand education and training efforts in geriatrics and gerontology led to the creation of four GECs in 1983. By 1989, 38 centers had been…
Pullen, Carol H.
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.
Peters, Claudia; Schablon, Anja; Bollongino, Kirsten; Maass, Monika; Kass, Dietmar; Dulon, Madeleine; Diel, Roland; Nienhaus, Albert
In order to characterize use of the Internet in medical geriatrics education programs, 130 medical education programs in the U.S. that train medical students, interns, residents, fellows and practicing physicians were asked to complete a survey developed by the Consortium of E-Learning in Geriatrics Instruction (CELGI). Sixty-eight programs…
Hajjar, Ihab M.; Ruiz, Jorge G.; Teasdale, Thomas A.; Mintzer, Michael J.
With improvement in medical services in the last few years, there has been a constant rise in the geriatric population throughout the world, more so in the developing countries. The elderly are highly prone to develop psychiatric disorders, probably because of age related changes in the brain, concomitant physical disorders, as well as increased stress in later life. Psychiatric disorders in this population may have a different presentation than in other groups and some of psychopathologies might be mistaken for normal age related changes by an unwary clinician. Therefore the need of the day is to train psychiatrists and physicians to better recognize and manage mental disorders in this age group. PMID:21327169
Varma, Sannidhya; Sareen, Himanshu; Trivedi, J.K.
Objective: We aimed to investigate the effect of rational pharmacotherapy workshop for interns on the rationality, cost and number of drugs prescribed. Methods: The participants were asked to prescribe a medication for acute noninflammatory osteoarthritis (ANOA), acute bacterial rhinosinusitis (ARS), acute otitis media (AOM), acute uncomplicated cystitis (AC), and acute bacterial tonsillopharyngitis (ABT) before and after workshop. Total 3000 prescriptions were scored regarding rationality of the drug choice (0-10), format (0-5), instructions (0-4), legibility (0-1) and total (0-20 points). The mean number of drug(s) and total costs per prescription were calculated. Paired samples t-test was used to compare the pre- and post score means. Results: Total pre- and post-prescribing scores (0-20) were significantly different (p=0.00 for each): ANOA (13.59±0.27, 18.33±0.18), ARS (13.26 ±0.18, 15.15 ±0.17), AOM (12.58 ± 0.26, 14.66±0.27), AC (13.53±0.17, 15.76±0.20), ABT (13.54±0.24, 15.49 ±0.28). Mean number of drugs per prescription for the indications in the pre-test and post-test were: ANOA (1.24 ±0.29, 1.02±0.01, p=0.00), ARS (2.08±0.04, 2.00±0.04, p=0.16), AOM (1.66±0.04 and 1.69±0.03, p=0.54), AC (1.55±0.04, 1.39±0.03, p=0.00) and ABT (2.10±0.05, 1.81±0.05, p=0.00). Mean costs per prescription in Turkish Liras: ANOA (6.31±0.29, 4.60±0.05, p=0.00), ARS (13.80±0.38, 4.63±0.04, p=0.00), AOM (10.18±0.28, 4.41±0.07, p=0.00), AC (11.33±0.21, 10.68±0.18, p=0.01) and ABT (12.03±0.34 and 10.41±0.35, p=0.00). Conclusion: Training produced a significant improvement in rational prescribing. PMID:24772132
Fevzi Dikici, Mustafa; Yaris, Fusun; Artiran Igde, Fusun; Yarar, Fulya; Altuntas, Oznur; Alper Gurz, Aysenur
During 1996, 585 patients, aged 55 to 96, were admitted into hospital at the Geriatric Department of Ospedale Maggiore (Turin). Acute confusion was seen in 22.2% of these patients who tended to have more serious clinical condition, were more likely to have chronic cognitive impairment, were treated with a greater number of drugs and suffered more from immobility with pressure ulcer. The confusional state, manifested at admission to Geriatric department, was mostly related with the patient's clinical severity, while the one which developed during hospital stay was linked to situations of physical frailty, as pressure ulcer and low albumin values. The most frequent causes of acute confusional state were acute infectious diseases, heart failure, gastro-intestinal bleeding with secondary anaemia, stroke and dehydration. In many cases the very cause of the acute confusional state could not be identified. Falls, more than 31 days length of stay in hospital and death were more frequent in patients suffering from confusional state. Chronic cognitive impairment, functional dependence, clinical severity and treatment involving a great number of drugs, are the main contributing factors in this syndrome. Thus, a multi-dimensional evaluation which takes into account both clinical-functional and socio-economical aspects, is useful for a correct preventive and diagnostic approach of acute confusional state. PMID:9676128
Zanocchi, M; Vallero, F; Norelli, L; Zaccagna, B; Spada, S; Fabris, F
Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent. PMID:16735082
Volkert, D; Berner, Y N; Berry, E; Cederholm, T; Coti Bertrand, P; Milne, A; Palmblad, J; Schneider, St; Sobotka, L; Stanga, Z; Lenzen-Grossimlinghaus, R; Krys, U; Pirlich, M; Herbst, B; Schütz, T; Schröer, W; Weinrebe, W; Ockenga, J; Lochs, H
not count toward the 18 direct patient care credits within the UW clinical campus required during fourth sites may be at medical schools, government clinics and hospitals, and private or non carefully consider their goals, expectations, language abilities, living conditions, and site safety when
As the number of individuals older than 65 years increases, there is a concomitant need for more nurses to provide care meeting the unique needs of older adults. The nursing shortage presents a challenge to schools of nursing to educate enough practitioners in geriatric nursing. The John A. Hartford Foundation Center of Geriatric Nursing Excellence at the University of Minnesota has developed a program to prepare nurse faculty to meet this challenge. The program, Faculty Learning About Geriatrics (FLAG), is designed to develop expertise in geriatric nursing, teaching, and academic leadership among faculty from academic settings in the upper Midwest and tribal colleges. This article chronicles the authors' experience in designing, implementing, and evaluating the first year of the FLAG program. PMID:20481423
Krichbaum, Kathleen; Kaas, Merrie; Mueller, Christine A; Wyman, Jean F
Objective. To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students’ skills related to consultant pharmacists’ roles and patient care responsibilities. Design. A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions. Assessment. After completing the IPPE, students’ geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students’ care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive. Conclusions. This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students’ abilities to serve the growing geriatric population. PMID:21931453
Boyce, Eric; Patel, Rajul A.
Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU) where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors) and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care, but also improved staff knowledge and satisfaction. The model may then be transposed across various locations and disciplines in the acute hospital where delirious patients could be sited. Trial Registration Current Controlled Trials ISRCTN52323811 PMID:21838912
This study used a Competency Questionnaire modified for medical surgical patients (CQ-Med). Twenty-nine patients (ages 65-94 years) admitted to a geriatric medicine unit were studied. Along with the CQ-Med, patients were administered several WAIS-R subtests, the Blessed Dementia Scale (BDS), and Mini Mental State Exam (MMSE). Additionally, a blind forensic evaluation for competency to consent to hospitalization and treatment was performed for the purpose of validation of the CQ-Med. Results of the study found that, as expected, increased age was correlated with decreasing performance on the CQ-Med and decreased findings of competence by clinical exam. However, there was great variability within each age group, demonstrating individual differences in the progress of declining competency. CQ-Med scores also correlated well with the WAIS-R subtest raw and scaled scores. Scores on the MMSE and BDS were less well correlated. The CQ-Med may be a useful adjunct in assessing declining competency in geriatric patients. PMID:19486444
Billick, Stephen B; Perez, Dolores R; Garakani, Amir
Background Students may encounter difficulties when they have to apply clinical skills trained in their pre-clinical studies in clerkships. Early clinical exposure in the pre-clinical phase has been recommended to reduce these transition problems. The aim of this study is to explore differences in students' experiences during the first clerkships between students exclusively trained in a skills laboratory and peers for whom part of their skills training was substituted by early clinical experiences (ECE). Methods Thirty pre-clinical students trained clinical skills exclusively in a skills laboratory; 30 peers received part of their skills training in PHC centers. Within half a year after commencing their clerkships all 60 students shared their experiences in focus group discussions (FGDs). Verbatim transcripts of FGDs were analyzed using Atlas-Ti software. Results Clerkship students who had participated in ECE in PHC centers felt better prepared to perform their clinical skills during the first clerkships than peers who had only practiced in a skills laboratory. ECE in PHC centers impacted positively in particular on students’ confidence, clinical reasoning, and interpersonal communication. Conclusion In the Indonesian setting ECE in PHC centers reduce difficulties commonly encountered by medical students in the first clerkships. PMID:22640419
Objective: To evaluate drug utilization pattern in terms of defined daily dose along with pharmacoeconomic analysis in geriatric patients admitted in medical ward of a tertiary care hospital. Materials and Methods: Retrospective medical record analysis was performed for indoor cases of the geriatric patients (age ?65 years) admitted in medicine ward from January 2010 to December 2010 were analyzed for demographics, indications for admission, various systems involved, duration of hospital stay, various drugs prescribed, and adverse drug reaction. The drugs were categorized by anatomical therapeutic classification and defined daily dose was calculated. The World Health Organization prescribing indicators were assessed. Cost of the drugs was calculated to assess the economic burden. Results: Cardiovascular diseases were the common cause for admission. Antiplatelet drugs-B01AC (93%), H2 blockers-A02BA (77.22%), antiemetics-A03FA (67.6%), vasodilators-C01D (55%), and hypolipidemic drugs-C10AA (52%) were commonly utilized groups. Average number of drugs per patient was 9.37 (95% CI: 9.09-9.64). Average number of antimicrobials prescribed per patient was 0.91 (95% CI: 0.82-0.99). Cefotaxime was the commonly prescribed antimicrobial drug. Average cost of treatment was ?540.5 (95% CI: ?458.0-623.0). Patients shared 45% of the economic burden for prescribed medicines. The average economic burden for drugs was significantly higher in expired than survived patients (?749.49 vs. 457.59). Conclusion: Polypharmacy and irrational use of medicines are common problems in geriatric prescription. Prescription guidelines should be formatted for them. PMID:24554905
Jhaveri, Binit N.; Patel, Tejas K.; Barvaliya, Manish J.; Tripathi, C. B.
. That clerkship will be one of multiple options available to fulfill a required rural rotation. Productive included expanding the specialties participating in the current rotation (the emphasis is now on family medicine; the addition of geriatrics, surgery, pediatrics and mental health were consistently cited
Chapman, Michael S.
...planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and Clinical Centers. No time will be...
...planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education, and Clinical Centers. No time will...
...planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and Clinical Centers. No time will be...
...boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT...boned poultry and baby or geriatric food. (a) Canned boned...
...boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT...boned poultry and baby or geriatric food. (a) Canned boned...
...boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT...boned poultry and baby or geriatric food. (a) Canned boned...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education, and...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education, and...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care, recent VHA efforts regarding dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and...
...Health Administration (VHA) strategic planning activities in geriatrics and extended care; recent VHA efforts regarding dementia and program advances in palliative care; and performance and oversight of VA Geriatric Research, Education, and...
This work is part of a larger study carried out at the Murray Royal and Murthly Hospitals within the Tayside Health District. The survey was concerned with staff attitudes towards geriatric psychiatry patients and shows that the nurses in these peripheral hospitals hold a positive attitude towards this area of nursing. These findings appear to contradict the popular opinion held throughout the nursing service, that the geriatric psychiatry nursing area is very unpopular with trained, untrained and learner nurses. In the study by Hooper [Nursing Times (1981) 77 37-40/43-44], anxiety levels among learners towards the geriatric nursing areas were found to be very high. This appears to correlate with Kogan [Journal of Abnormal and Social Psychology (1961) 62, 616-622], which summarized is as follows: Young subjects were imputed to have a more consistently negative view of old people.' By using a series of two precoded questionnaires that the subjects completed, an overview of staff attitudes towards the geriatric psychiatry areas was obtained. The hypothesis on which the study was based was as follows: that a negative view towards geriatric psychiatry would be found among the staff of the Murray Royal and Murthly Hospitals.' However, the findings of this study did not support the hypothesis on any counts and gave a highly positive attitude scale. PMID:6550063
Jones, R G; Galliard, P G
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…
Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea
There is evidence that geriatric services may be more effective in handling problems of the elderly in acute care. We therefore studied a cohort of matched triplets (age, gender and admission diagnosis), to assess the effect of a geriatric service on elderly problems (falls, pressure ulcers, delirium and functional decline). This is a follow up study; comparing a geriatric unit
Mario Ulises Pérez-Zepeda; Luis Miguel Gutiérez-Robledo; Sergio Sánchez-Garcia; Teresa Juárez-Cedillo; Jose Juan García Gonzalez; Francisco Franco-Marina; Carmen García-Peña
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,…
Thielke, Stephen; Tumosa, Nina; Lindenfeld, Rivkah; Shay, Kenneth
Apolipoprotein E (APOE) has been associated with a variety of late-life neuropsychiatric disorders, including geriatric depression. This study determined whether APOE genotypes affect vulnerability to geriatric depression. We also tested the effect of the presence of the APOE ε4 (APOE4) allele on age of onset, suicide attempt history and cognitive function in geriatric depressed patients. We genotyped APOE in 111
Jen-Ping Hwang; Chen-Hong Yang; Chen-Jee Hong; Jiing-Feng Lirng; Ya-Min Yang; Shih-Jen Tsai
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.
Golden, Daniel W., E-mail: firstname.lastname@example.org [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Spektor, Alexander [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Rudra, Sonali; Ranck, Mark C. [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Krishnan, Monica S.; Jimenez, Rachel B.; Viswanathan, Akila N. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J. [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States)
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
Clement, R Carter; Ahn, Jaimo; Mehta, Samir; Bernstein, Joseph
Vitamin B12 deficiency or cyanocobalamin is a common condition in the elderly. It is repeatedly overlooked due to multiple clinical manifestations that can affect the blood, neurological, gastrointestinal, and cardiovascular systems, skin and mucous membranes. The various presentations of vitamin B12 deficiency are related to the development of geriatric syndromes like frailty, falls, cognitive impairment, and geriatric nutritional syndromes like protein-energy malnutrition and failure to thrive, in addition to enhancing aging anorexia and cachexia. Therefore, interventions must be developed to include their screening and diagnosis to make early and appropriate treatment to prevent its complications before they become irreversible. PMID:24892321
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 attention to a variety of concerns. Using examples and illustrations from an ongoing gerontology internship component (undergraduate and graduate) this article examines ways to anticipate and address the challenges that are common to a broad range of internship experiences, as well as those that are unique to applied learning in gerontology and geriatrics. PMID:19927250
Karasik, Rona J
The 1994 Nutrition Guidelines reinforce that all nutritional plans for people with diabetes should be individualized, which is particularly important and necessary for elderly patients. The geriatric population poses many unique challenges to the healthcare professional due to physiological changes and many other risk factors that affect nutritional status either directly or indirectly. A thorough nutritional assessment that includes an evaluation of the potential nutritional risk factors described in this article can help in developing an effective and realistic nutritional plan for achieving and maintaining good blood glucose control and good nutritional status in geriatric patients with diabetes. PMID:9526323
Evidence-based medicine (EBM) is the rubric for an approach to learning and practicing medicine that applies skills from clinical epidemiology, library science, and information management to clinical practice. Teaching EBM effectively requires a longitudinal approach throughout medical education. This presents many opportunities for academic emergency physicians, especially in the setting of an emergency medicine clerkship. EBM is best taught at the bedside, although this depends on a skilled and interested faculty. Bedside teaching of EBM also requires ready access to modern information resources. Other venues for teaching EBM include morning report, teaching conferences, and journal clubs. Many tools can be used to aid the process, including Web-based sources such as UpToDate, textbooks, and Web-based tutorials, educational prescriptions, and critically appraised topics. PMID:15579428
Ismach, Richard B
Of all long term care settings, the nursing home has served as the most productive laboratory for the study of the mental health problems of late life. Lessons from geriatric psychiatry research and practice in the nursing home have relevance to general psychiatry and to other health care settings, informing us about (a) psychiatric disorders in medically ill and disabled
Joel E. Streim; David Oslin; Ira R. Katz; Patricia A. Parmelee
[Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem scale, a social support scale, and a life satisfaction scale. Data were collected from April 20 to June 20, 2011. Data were analyzed using descriptive statistics, Pearson correlations, and multiple logistic regression analysis using SPSS 15.0 and Stata 11.0. [Results] The average GDSSF-K score of the participants was 8.94, indicating a moderate level of depression. About 78.4% of the elderly patients in this study were classified as predisposed toward depression. Significant predictors for depression included the patients' perceived health status and life satisfaction. [Conclusion] The results indicate that elderly patients face a high risk of developing depression and that efforts should be made to address it wherever possible. Regular depression screening will be beneficial for early detection of depression in patients at community geriatric hospitals. PMID:24396207
Jee, Young Ju; Lee, Yun Bok
Regeneration of skeletal muscle depends on a population of adult stem cells (satellite cells) that remain quiescent throughout life. Satellite cell regenerative functions decline with ageing. Here we report that geriatric satellite cells are incapable of maintaining their normal quiescent state in muscle homeostatic conditions, and that this irreversibly affects their intrinsic regenerative and self-renewal capacities. In geriatric mice, resting satellite cells lose reversible quiescence by switching to an irreversible pre-senescence state, caused by derepression of p16(INK4a) (also called Cdkn2a). On injury, these cells fail to activate and expand, undergoing accelerated entry into a full senescence state (geroconversion), even in a youthful environment. p16(INK4a) silencing in geriatric satellite cells restores quiescence and muscle regenerative functions. Our results demonstrate that maintenance of quiescence in adult life depends on the active repression of senescence pathways. As p16(INK4a) is dysregulated in human geriatric satellite cells, these findings provide the basis for stem-cell rejuvenation in sarcopenic muscles. PMID:24522534
Sousa-Victor, Pedro; Gutarra, Susana; García-Prat, Laura; Rodriguez-Ubreva, Javier; Ortet, Laura; Ruiz-Bonilla, Vanessa; Jardí, Mercè; Ballestar, Esteban; González, Susana; Serrano, Antonio L; Perdiguero, Eusebio; Muñoz-Cánoves, Pura
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…
Karasik, Rona J.
Quality of life is an important issue for geriatric patients. Allowing periodontal disease, fractured teeth, and neoplasia to remain untreated decreases this quality of life. Age itself should be recognized; however, it should not be a deterrent to successful veterinary dental care. PMID:15833566
Holmstrom, Steven E
Pre/post course evaluations by 35 students in an interdisciplinary geriatric training program delivered via distance methods indicated an increase in interdisciplinary team skills. Students working with older clients had better attitudes about teams and were motivated to seek additional training. Distance delivery enabled outreach to underserved…
Coogle, Constance L.; Parham, Iris A.; Welleford, E. Ayn; Netting, F. Ellen
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…
Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur
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…
Shapiro, Johanna; Cho, Beverly
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)
and health care of older adults in West Virginia by enhancing geriatrics training and competency of our state's health professionals that care for our older citizens. Our mission includes creating a sustainable's Center on Aging, was a beloved professor specializing in public policy and aging, community based care
Vision impairment is highly prevalent yet un- detected in the elderly population. Without screening and early detection age-related vi- sion loss can lead to various adverse effects. The purpose of this review is to assess the methods of screening geriatric patients for visual impairment that can be employed by nurse practitioners in the primary care set- ting. A series of
Melissa A. Kalinowski
Institute of Gerontology in the College of Public Health. All rights reserved. No portion of this report in Gerontology and Geriatrics Armstrong Atlantic State University College of Health Professions Health Sciences of Psychology Center for Mental Health & Aging Tuscaloosa, AL 35487 (205) 348-7518 University of Georgia
BACKGROUND: Effective stroke intervention and risk reduction depend on the general public's awareness and knowledge of stroke. In Korea, where both traditional Oriental medicine and Western medicine are practiced, estimates of the general public's awareness and knowledge of stroke are poor. The present study sought to describe the inception cohort of the Ansan Geriatric Study (AGE study) and to determine
Moon Ho Park; Sangmee Ahn Jo; Inho Jo; Eunkyung Kim; Su-Yong Eun; Changsu Han; Min Kyu Park
Background Geriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult’s medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality). Methods We searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks. Results We identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10–45min. Geriatric assessment was most often completed to describe a patient’s health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%–50% of treatment decisions. Conclusion Geriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed. PMID:22851269
The long-term use of non-steroidal anti-inflammatory agents in geriatric dogs with osteoarthritis has not been well studied in veterinary medicine. This study evaluated the effects of firocoxib administered to dogs over 7 years of age for 90 days. Pain and lameness scores were evaluated by the owner weekly for the 1st month and then biweekly through to the end of the study, the veterinarian evaluated the dogs monthly. Serum chemistry, including urea, creatinine, alanine transferase, aspartate transaminase, bile acids and bilirubin, urine specific gravity and a urine dipstick, were performed at monthly intervals. Forty-five dogs were enrolled into the treatment group and 9 into the control group. A total of 33 dogs completed the trial in the treatment group and 8 in the control group. Lameness and pain scores were found to be significantly lower in the treated group from day 30 for most parameters evaluated. Bile acids (although not comparable to controls, with higher mean value and a high standard deviation in the control group; in addition the control group had increased bile acids at day 0) and urea (within normal reference range provided (WNL)) were significantly different in the treatment group between days 0 and 90. Urea (WNL) on days 30 and 90 and creatinine (WNL) on day 90 were significantly different between the control group and the treatment group. The most common adverse events reported were diarrhoea, vomition, dark faeces and anorexia. This study showed that firocoxib was effective in managing pain associated with osteoarthritis for 90 days. Despite the geriatric high-risk population used for this study, minimal biochemical changes were seen and adverse drug events seen were in agreement with those previously reported. PMID:20169752
Joubert, K E
Long before modern medicine thought of old age as a disease, the Greeks and Romans appear to have referred to it as such and their learned men to have worked out theories on similar lines. Aristotle distinguished old age as a "natural" disease; both he and the Hippocratic school sought to devise a pathology of aging on the basis of the four "humours." Both were agreed that a loss of heat lay at the root of the matter, but Aristotle thought this was accompanied by dryness, the Hippocratic school by humidity. In the end it was the Aristotelian position which posterity accepted and embraced into the last century. PMID:11866376
ObjectivesTo determine contentment with the performance of primary mission emergency care providers.MethodsA prospective cohort study was conducted using key informant interviews to assess quality of life and self-rated degree of contentment with care in geriatric emergencies.ResultsInterviews concerning a total of 152 geriatric emergency cases in nursing homes were conducted with patients in 13 (8.6%) cases, geriatric nurses in 132 (86.8%)
M. K. Bluemel; C. Traweger; J. F. Kinzl; M. A. Baubin; W. Lederer
Giant splenic artery aneurysms (GSAAs) larger than 8 cm in diameter have rarely been reported, particularly in older people. They are clinically important lesions, often asymptomatic and related to an increased risk of complications such as abrupt rupture, requiring emergency surgical treatment. Comprehensive geriatric assessment (CGA), originally developed for multidimensional clinical evaluation in several geriatric settings, was recently proposed as a fundamental preoperative aid for treatment planning of older patients undergoing elective surgery and preventing adverse post-operative outcomes. We present the first case of an asymptomatic 9-cm partially thrombosed GSAA, accidentally diagnosed during abdominal ultrasound in a 63-year-old woman from the Apulia region in Southern Italy. She successfully underwent aneurysmectomy, highlighting the usefulness of CGA in elective surgical patients. PMID:22526082
Orsitto, Giuseppe; Fulvio, Francesco; Pinto, Antonio G; Turi, Vincenzo; Tria, Domenico; Venezia, Amedeo; Colucci, Clementina; Castellana, Roberto; Manca, Cosimo
Risk factors for acute cerebral ischemia in geriatrics were assessed in two groups of 100 patients by comparing anamnestic data (based on a personal questionnaire) to laboratory data. The first group included patients affected by ischemic ictus not more than 45 days prior to the start of the study; the second group comprised geriatric subjects whose clinical characteristics were considered "normal for their age". The study took into account both the quality and quantity of findings. It was observed that risk factors play a more important role in women. Arterial hypertension, cardiopathies, cerebrovascular symptomatology, drug therapy, hyperfibrinogenemia and the number of red blood cells were the most important risk factors, followed by hematocrit, hemoglobin, total cholesterol and ATS ratio. The importance of the familiar factor for women and the lack of a role for HDL cholesterol in men were underlined. PMID:2041617
Giuliani, G C; Fumelli, T; Pepi, R; Zanfei, A; Silvestro, M
Vision impairment is highly prevalent yet undetected in the elderly population. Without screening and early detection age-related vision loss can lead to various adverse effects. The purpose of this review is to assess the methods of screening geriatric patients for visual impairment that can be employed by nurse practitioners in the primary care setting. A series of databases were searched utilizing the key words aged, geriatric, vision, vision tests, and screening. The Snellen chart, Pinhole assessment, Ophthalmoscope, Cardiff acuity test, Amsler grid, and subjective measures are discussed. All must be utilized cautiously because research has shown that these screening methods are limited in their sensitivity and specificity in detecting ocular disease. No combination of tools is ideal for identifying age-related vision loss although implications for practice are implied. PMID:18394513
Kalinowski, Melissa A
Urinary tract infections (UTIs) are common and generally benign conditions among healthy, sexually active young women without long-term medical sequelae. In contrast, UTIs are more complicated among those individuals at either end of the age spectrum: infants\\/young children and geriatrics. UTI in children younger than 2 years has been associated with significant morbidity and long-term medical consequences, necessitating an extensive
Linda M. Dairiki Shortliffe; Jack D McCue
While the geriatric population covers an age range of 30 to 40 years people over age 60 are often treated as a homogenous group. To study the possibility of age changes and differences within the older population, data were collected from the charts of 60 patients (randomly selected within each of three age groups: 60-69, 70-79, 80-89) of an…
Kramer, Nanette A.; And Others
The authors hypothesized that an interprofessional workshop would improve geriatrics trainees' medication management. The workshop was based on a needs assessment and comprised an interactive session with pharmacists on managing medications in elderly adults. Participants were trainees in their geriatrics rotation at a tertiary care medical center. Trainees completed a medication appropriateness survey for three patients, one of which was their own. After the workshop, trainees reviewed medications of the three patients. Trainees completed online surveys after their rotation and 3 months later. Of 95 trainees rotating through geriatrics, 76 (80%) attended the workshop and completed the worksheet. Trainees' scores on reviewing medication lists improved significantly, from 6.7±2.3 to 7.7±2.0 out of 11 for standardized patient 1 (P<.001) and from 5.7±1.8 to 6.4±1.5 out of 11 for standardized patient 2 (P=.009). Trainees' scores on their own patients' lists also improved significantly, from 5.6±1.5 to 6.6±1.5 out of 10 (P<.001). After the workshop, 95% (71/75) planned to change the medication regimen of the patient they presented, and 93% (68/73) planned to change other patients' medications based on information learned during the workshop. Three months later, 35% (12/34) had made changes to the regimen of the patient they discussed during the workshop, and 71% (15/21) had made changes to other patients' regimens. Seventy-eight percent (18/23) rated the workshop as the top nonclinical experience of their geriatrics rotation. In conclusion, this interprofessional medication management workshop improved trainees' ability to perform medication reviews accurately and led to change in self-reported prescribing behavior. PMID:25040361
Kostas, Tia; Zimmerman, Kristin; Salow, Marci; Simone, Mark; Whitmire, Natalie; Rudolph, James L; McMahon, Graham T
A three-year home-teaching demonstration project with the geriatric blind was conducted with 171 clients in the experimental group (132 were blind for 10 years or less and were 60 years of age or older, 11 were blind 17 years or longer, 7 were in an apartment group, 7 died, and 14 had incomplete records) and 44 clients in the control group. The…
Gobetz, Giles Edward; And Others
The proceedings in elective surgery on "Jehova's Witnesses" differ from customary operations. Intensive physical therapy, high complaint, internal and anesthesiologic examination, exact information about the risks and facilities as "cell-saving" etc. and postoperative planing are necessarily required ahead of the indication to operate. Additional complications may be possible. The higher costs are balanced by avoiding, respectively getting rid of disability, immobilisation and the needing of care. A religious dogma leads to a special point of view towards life, death, health and expectations towards' the life and its quality as well as social support. It is a difficult undertaking in elective surgery to bring this dogma and our ethic and moral values into accord. It is not medicine vs. religion, but to point out a way and the limits by respecting the individual ideology, abstract conceptions and philosophy of life. PMID:9190742
Schulz, R; Schmitt, E
The incidence of cancer increases with advanced age. Unfortunately, there is a significant lack of evidence regarding the safety and efficacy of treatments. The oncology community also lacks information regarding which older patients are most likely to benefit from treatment without undue toxicities. Interventions to lower symptoms and reduce long-term complications from cancer and cancer treatment in older patients are urgently needed. Establishing research priorities in geriatric oncology could help guide researchers and focus efforts on interventions that have the highest likelihood of improving outcomes. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and National Cancer Institute, held linked conferences as part of a U13 grant in September of 2010 and November of 2012, summarising the gaps in knowledge in geriatric oncology and recommending ways to close these gaps. The overall purpose of this review is to highlight the important research priorities in geriatric oncology from the literature and from the previous U13 meetings. More evidence regarding the treatment of older cancer patients is urgently needed given the rapid aging of the population. PMID:25346565
Mohile, Supriya; Dale, William; Magnuson, Allison; Kamath, Nayana; Hurria, Arti
Prostate cancer is the most common non-cutaneous cancer in US men and mainly affects elderly patients, with most new diagnoses occurring in those over 65. As the geriatric population in the US continues to grow, the incidence of this disease is likewise expected to rise. Many older patients are diagnosed with advanced disease or are treated only when their disease becomes symptomatic or metastatic. The treatment options for advanced prostate cancer have increased dramatically in the last decade. It is important to understand the nuances of caring for an elderly cancer patient in order to optimally treat prostate cancer, such as the importance of using a geriatric assessment to uncover overlooked or under-reported vulnerabilities. In addition, many of the newly approved agents for the treatment of advanced prostate cancer have a unique mechanism of action and toxicities that warrant consideration when choosing therapies for older patients. This review focuses on the importance of a geriatric assessment as well as the considerations of treating elderly patients with the newer agents approved for prostate cancer. PMID:24860655
Kessler, Elizabeth R.
. Assessment and Management Tools for Select Geriatric Syndromes (cognitive impairment, gait and balance Decisions (systematic approach to negotiating difficult decisions, driving and older patients) 8. Geriatric
& Medical Humanities Patient SafetyMedical NutritionMedical InformaticsGender Based Medicine Geriatrics & Principles of Pallative Care Psychiatry M1 Cellular Function and Medical Genetics (8 weeks) Structure./Fam. Medicine Neurology March April Pediatrics Graduates begin Residency Training as M.D. July USMLE STEP 1
& Medical Humanities Patient SafetyMedical NutritionMedical InformaticsGender Based Medicine Geriatrics & Principles of Pallative Care Psychiatry M1 Cellular Function and Medical Genetics (8 weeks) Structure and Behavior (7 weeks) Int./Fam. Medicine Neurology March April Pediatrics June Focused Inquiry and Research
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
Monajjemzadeh, Farnaz; Shokri, Javad; Mohajel Nayebi, Ali Reza; Nemati, Mahboob; Azarmi, Yadollah; Charkhpour, Mohammad; Najafi, Moslem
Purpose To examine how pediatricians in private practices are affected by the process of training medical students in their clinics as part of a community-based clerkship program. Materials and Methods In 2007, a questionnaire was sent to 35 pediatricians who had provided private clinical settings for clerkship training for the previous 3 years. The questionnaire covered a number of points, including the pediatricians' motivation to join and/or reasons to quit the program; if there were changes seen in their stress levels while supervising students; changes in their treatment procedures or attitudes because of the students' presence; responses of patients and/or their guardians in regard to have medical students treating them, and whether the doctors were inspired to grow professionally by participating in the program. Results Of the 35 pediatricians, 31 (88.5%) responded. Eighteen respondents (58%) selected 'responsibility to cooperate with medical school' as a reason to participate. Fifteen physicians (48.3%) answered that the clerkship program had a positive impact on their treatment procedures and their attitude towards patients. Conclusion Based on the pediatricians' responses, the community-based clerkship program may instill intellectual inspiration and promote professional growth among the pediatricians in private practices, resulting in potentially better treatment for patients. PMID:19881962
Kim, Young Jon; Joo, Chan Uhng; Kim, Jung Soo; Kim, Jung Soo
Aims and objectives To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses’ perception of their practice and its’ relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs Discursive paper. Method In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals’ systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff’s perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults. PMID:23083387
Capezuti, Elizabeth; Boltz, Marie; Cline, Daniel; Dickson, Victoria Vaughn; Rosenberg, Marie-Claire; Wagner, Laura; Shuluk, Joseph; Nigolian, Cindy
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
Miller, Stephannie; Fulton, Judith; Mostow, Eliot
Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the “lebenswelt” that describe the
Allan B. de Guzman; Reena-Jane D. Dangoy; Kathleen Christian V. David; Ken Jarrett H. Dayo; Keisha A. de Claro; Giorgio von Gerri G. de Guzman; Gerald Ian D. de Jesus
In 2007, the Health Resources Services Administration (HRSA) introduced new mandates which raised the standards on program evaluation for Geriatric Education Centers. Described in this paper are the primary and secondary evaluation efforts undertaken for one program within the XX Geriatric Education Center (XXGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the
Rachel Filinson; Phillip G. Clark; JoAnn Evans; Cynthia Padula; Cynthia Willey
Changing U.S. demographics and family composition are challenging social work education programs to reposition and reconsider how to prepare students for practice in the field of geriatrics. Implications for future social service and health care needs include ongoing training and education of students with competencies in serving geriatric…
Behrman, Gary; Mancini, Michael; Briar-Lawson, Katharine; Rizzo, Victoria M.; Baskind, Frank; Valentine, Carl
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…
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
Purpose: We sought to characterize self-neglect definitively as a geriatric syndrome by identifying an association with functional impairment. Design and Methods: We performed a cross-sectional home evaluation of 100 community-living older adults referred by Adult Protective Services for geriatric self-neglect and 100 matched adults from a…
Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.
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
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.…
Martinez, Iveris L.; Mora, Jorge Camilo
Although geriatric rehabilitation continues to grow, little attention has been paid in the literature to the mental health issues of older adult minority patients. Given the prominence of depression in geriatric rehabilitation for dominant culture patients, the program of depression research and treatment described herein was targeted for urban African Americans. This program of research addressed four main questions: Is
Peter A. Lichtenberg
Geriatric oncology is increasingly developing in Western countries as it is established that cancer peaks after 60 years of age, and the populations are inexorably aging. Aging is associated with a decrease in the use of chemotherapy, and some patients are therefore exposed to undertreatment. Comprehensive geriatric assessment is a composite of several scores that target the multidimensional aspects of
Jean-Emmanuel Kurtz; Damien Heitz; Valérie Kurtz-Illig; Patrick Dufour
Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…
Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert
Baycrest Centre for Geriatric Care Patients with Severe Memory Loss Given Brighter Future with palmOne Handhelds Since 1918, Baycrest Centre for Geriatric Care has been devoted to enriching the quality of life of Toronto, Baycrest is advancing care in the 21st century through the power of research and education
Toronto, University of
Introduction Depression is the fourth leading cause of the global disease burden, and approximately one in four elderly people may suffer from depression or depressive symptoms. Depression in later life is generally regarded as highly treatable, but under-treatment is still common in this population, especially among those in rural areas where access to healthcare is often an issue. In this study rural primary care physicians’ practices, attitudes, barriers and perceived needs in the diagnosis and treatment of geriatric depression were described, and trends in care delivery examined. Methods A survey was sent to 162 rural Illinois family physicians and general internists. The survey focused on current practices, attitudes and perceptions regarding geriatric depression, barriers to and needs for improvement in depression care and physician and practice characteristics. Results Seventy-six physicians (47%) responded. The rural physicians indicated that over one-third of their patients aged 60 years and older were depressed. All reported routine screening for depression, with 24% using the Beck Depression Inventory. Overall, physicians expressed positive attitudes about their involvement in treating older depressed patients. However, 45% indicated a ‘gap’ between ideal and available care in their rural practices. Physicians with higher proportions of elderly patients in their panels were more likely to feel that more training in residency in geriatric care would be helpful in improving care, and that better availability of psychologists and counselors would be important for improvement of care for older, depressed patients. Conclusions This study responds to recent calls to better understand how primary care physicians diagnose and treat depression in older adults. Generally, primary care physicians appear comfortable and prepared in depression diagnosis and management, but factors such as availability of appropriate care remain a challenge. PMID:19929129
Glasser, M; Vogels, L; Gravdal, J
AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated. PMID:15637734
Kirchgatterer, Andreas; Steiner, Pius; Hubner, Dietmar; Fritz, Eva; Aschl, Gerhard; Preisinger, Josef; Hinterreiter, Maximilian; Stadler, Bernhard; Knoflach, Peter
Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database). Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration). Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity. A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties. Conclusions Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs. PMID:20663137
Background Growing evidence suggests that a comprehensive geriatric assessment (CGA) in older patients with cancer can detect unsuspected\\u000a health problems, predict survival, and predict tolerance to chemotherapy. However, studies regarding CGA in cancer patients\\u000a are scarce in Asia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We prospectively enrolled 65 elderly cancer patients who were candidates of systemic chemotherapy between July 2006 and March\\u000a 2008. Baseline CGA data including
Yu Jung Kim; Jee Hyun Kim; Myung-Sook Park; Keun-Wook Lee; Kwang-Il Kim; Soo-Mee Bang; Jong Seok Lee; Cheol-Ho Kim
This article describes the rapidly growing geriatric population in the United States. Current and emerging living arrangements include the subgroups of older adults who live at home, retirement villages, assisted living facilities, various levels of nursing homes, and hospice care. The degree of isolation and social connection is discussed and the need for dental care has been summarized from the literature. Demographic trends imply a substantial increase in both the need and demand for dental care by the senior age groups. A proposal to integrate oral health and dental care with primary care is provided. PMID:25201537
Douglass, Chester W; Jiménez, Monik C
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
Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L
Introduction: There has been a recent increase in interest in implementing organized geriatric fracture programs for care of older adults with fragility fractures in order to improve both the quality and costs of care. Because such programs are relatively new, there are no standardized methods for implementation and no published descriptions of barriers to implementation. Materials and Methods: An online survey tool was sent to 185 surgeons and physicians practicing in the United States, who are involved with geriatric fracture care. Sixty-eight responses were received and evaluated. Results: Barriers identified included lack of medical and surgical leadership, need for a clinical case manager, lack of anesthesia department support, lack of hospital administration support, operating room time availability, and difficulty with cardiac clearance for surgery. Other issues important to implementation included quality improvement, cost reductions, cost to the hospital, infection prevention, readmission prevention, and dealing with competing interest groups and competing projects mandated by the government. Physicians and surgeons felt that a site visit to a functioning program was most important when considering implementing a hip fracture program. Conclusions: This study provides useful insights into barriers to implementing an organized hip fracture program. The authors offer suggestions on ways to mitigate or overcome these barriers. PMID:23569692
Kates, Stephen L.; O'Malley, Natasha; Friedman, Susan M.; Mendelson, Daniel A.
Purpose To analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients. Patients and methods The clinical data of 17 geriatric patients with foreign-body aspiration were retrospectively analyzed and compared with 26 nongeriatric adult patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2000 and June 2014. Results (1) In the geriatric group, the most common symptoms were cough and sputum (15 cases, 88%), dyspnea (six cases, 35%), and hemoptysis (four cases, 24%). Five patients (29%) in the geriatric group could supply the history of aspiration on their first visit to doctor, a smaller percentage than in the nongeriatric group (13 cases, 50%). Only three cases in the geriatric group were diagnosed definitely without delay. Another 14 cases were misdiagnosed as pneumonia or lung cancer, and the time of delayed diagnosis ranged from 1 month to 3 years. Complications due to delay in diagnosis included obstructive pneumonitis, atelectasis, lung abscess, and pleural effusion. (2) Chest computed tomography demonstrated the foreign body in three cases (21%) in the geriatric group, which was lower than the positive proportion of detection in the nongeriatric group (nine cases, 35%). The most common type of foreign body in the geriatric group was food, such as bone fragments (seven cases, 41%) and plants (seven cases, 41%), and the foreign body was most often lodged in the right bronchus tree (eleven cases, 65%), especially the right lower bronchus (seven cases, 41%). Flexible bronchoscopy removed the foreign body successfully in all patients. Conclusion The clinical features of foreign-body aspiration in geriatric patients are usually more obscure than in nongeriatric adults, which may lead to long delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management in geriatric patients. We suggest flexible bronchoscopy as the first-line approach to similar patients, especially those with aspiration history and unexplained pneumonia. PMID:25284994
Lin, Lianjun; Lv, Liping; Wang, Yuchuan; Zha, Xiankui; Tang, Fei; Liu, Xinmin
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
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
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-morbidity, and patient reported outcomes assessment. PMID:21232097
Background An accurate prediction of unplanned readmission (UR) after discharge from hospital can facilitate physician's decision making\\u000a processes for providing better quality of care in geriatric patients. The objective of this study was to explore the association\\u000a of cardiac autonomic functions as measured by frequency domain heart rate variability (HRV) and 14-day UR in geriatric patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Patients admitted to the geriatric
Jui-Kun Chiang; Chin-Hua Fu; Terry BJ Kuo; Malcolm Koo
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)
Badawi, Ramsey D.
AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (? 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors. PMID:20976846
Suzuki, Yutaka; Tamez, Seryna; Murakami, Akihiko; Taira, Akihiko; Mizuhara, Akihiro; Horiuchi, Akira; Mihara, Chie; Ako, Eiji; Muramatsu, Hirohito; Okano, Hitoshi; Suenaga, Hitoshi; Jomoto, Kazuaki; Kobayashi, Junya; Takifuji, Katsunari; Akiyama, Kazuhiro; Tahara, Koh; Onishi, Koji; Shimazaki, Makoto; Matsumoto, Masami; Ijima, Masashi; Murakami, Masato; Nakahori, Masato; Kudo, Michiaki; Maruyama, Michio; Takahashi, Mikako; Washizawa, Naohiro; Onozawa, Shigeru; Goshi, Satoshi; Yamashita, Satoyoshi; Ono, Shigeki; Imazato, Shin; Nishiwaki, Shinji; Kitahara, Shuichirou; Endo, Takao; Iiri, Takao; Nagahama, Takeshi; Hikichi, Takuto; Mikami, Tatsuya; Yamamoto, Tetsuo; Ogawa, Tetsushi; Ogawa, Tomoko; Ohta, Tomoyuki; Matsumoto, Toshifumi; Kura, Toshiroh; Kikuchi, Tsutomu; Iwase, Tsuyoshi; Tsuji, Tsuyotoshi; Nishiguchi, Yukio; Urashima, Mitsuyoshi
Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person's privacy. Attending a day centre confers much benefit, but one must understand the old person's resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person's competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated. PMID:15923486
Rosin, A; van Dijk, Y
Giving fluids via the subcutaneous route is a safe and effective technique for the prophylaxis and for the treatment of dehydration. Side effects occur rarely when using this access route compared to the intravenous route, which has a much higher rate of side effects. Subcutaneous infusions can be used to treat inpatients in a hospital setting, in nursing homes, and in patients living at home. One great advantage of the subcutaneous route is that it is not necessary to have a physician to prepare a subcutaneous line, which can also be performed by trained nursing staff. Agitated patients who frequently pull out their lines themselves are a group where the subcutaneous route is particularly useful. Subcutaneous infusions can avoid the necessity for admission of geriatric patients to a hospital. PMID:23052283
Leischker, A H
Aging of the "baby-boom" generation and increased life expectancy will mean a projected population increase of persons 65 and older from 39 to 65 million between 2010 and 2030. Surveys conducted among members of the American Association of Retired Persons (AARP) reflect their wish to establish a more equal part in the physician-patient relationship and to participate in local and federal health care monitoring and reform. Accordingly, many are asking for health information and are prepared to change heretofore ineffectual communication with the health care system--whether in their personal physician's office or at the federal level. Only a fraction of practicing physicians report geriatrics as a primary or secondary specialty. Family practitioners and internists are likely to continue to provide the major share of medical care to the elderly in the future. PMID:10294289
Harvey, C A
The aim of this study is to investigate the occurrence of elderspeak in a Swedish context and to describe its characteristics. Elderspeak refers to adjustments made in communication with elderly people; adjustments similar to those made in interaction with infants. Previous findings show that adjustments of communication are made within several linguistic domains, and are a part of the communicative environment of elderly people. Five people working in different forms of geriatric institutions participated in this study, and data consist of recordings of interactions between caregivers and residents (without dementia) and interactions between caregivers and colleagues. The recordings were transcribed and analyzed by means of perceptual, semantic and acoustic analyses. The findings demonstrate that caregivers, to a varying extent, adjusted their communication within several linguistic domains. The adjustments were mainly made within the prosodic domain, but there were also adjustments made within other language domains. PMID:23806132
Samuelsson, Christina; Adolfsson, Elin; Persson, Hanna
For nurses interested in keeping up to date with developments in geriatric treatment, this set of resources created by expert practitioners will be quite a find. The entire site was developed as part of the Nurse Competence in Aging initiative created by the American Nurses Association. Here, visitors can read over twenty-five two-page assessment tools that include such helpful titles as Ã¢ÂÂAssessing Nutrition in Older AdultsÃ¢ÂÂ, Ã¢ÂÂPredicting Pressure Ulcer RiskÃ¢ÂÂ, and Ã¢ÂÂImmunizations for the Older AdultÃ¢ÂÂ. Written in clear and direct language, these resources will also be of assistance for nursing educators and those who are responsible for professional development workshops. It is also worth mentioning that these short tools are designed as screening tools, and are not for diagnosis.
Geriatric dermatoses are a challenging job for the physician in terms of diagnosis, management, and followup. Since skin of the elderly population is going through a lot of changes from both an intrinsic and extrinsic point of view, it is imperative for the physician to have a better understanding of the pathophysiology of geriatric skin disorders and their specific management, which differs slightly from an adult population. This review focuses on a brief introduction to the pathophysiological aspects of skin disorders in elderly, the description of some common geriatric skin disorders and their management and the new emerging role of psychodermatological aspects of geriatric dermatoses is also discussed. At the end, ten multiple choice questions are also added to further enhance the knowledge base of the readers. PMID:22515576
Jafferany, Mohammad; Huynh, Trung V; Silverman, Melissa A; Zaidi, Zohra
Rotation Swap Policy Protocol Rotations are clinical assignments that involve treating patients. They are: Geriatric Dentistry, Oral and Maxillofacial Surgery, Pediatric Dentistry, Emergency, Periodontology, Orthodontics and Postgraduate Prosthodontics. Students are required to attend the rotations
Methods of conducting comprehensive geriatric evaluation and management (GEM) are proliferating in a variety of clinical settings. However, rigorous evaluations of efficacy for this new approach to care of older patients have demonstrated a favorable impact on patient outcome in only a few studies. All of these have been controlled single site studies, and replication is needed. If replication studies show similar results, further studies should be undertaken to define the minimum necessary intervention to achieve the desired outcome. Controlled trials are needed to determine if consultative geriatric evaluation and/or primary patient management is effective. Further innovative work is needed in model development for geriatric assessment and management in outpatient settings. Finally, studies of geriatric evaluation and management in other environments, such as home care or the nursing home, are recommended. PMID:1885877
Jahnigen, D W; Applegate, W B; Cohen, H J; Epstein, A; Granger, C; Hogan, D; Kennedy, R; Lazaroff, A
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…
Bonifas, Robin P.; Gray, Amanda K.
Background. There is growing evidence for the significant involvement of inflammatory processes in the development of muscle wasting in old age. Therefore, any disease accompanied by inflammation can be threatening to the muscle function in geriatric patients. Methods. Sixty-three hospitalized geriatric patients (42 female, 21 male; mean age 84.2 6 5.7 years) were monitored weekly for muscle function (grip strength,
Ivan Bautmans; Rose Njemini; Margareta Lambert; Christian Demanet; Tony Mets
ObjectiveThe objective of this study was to establish the rates and to gather information from patients, staff and family members on risks and potential measures to prevent patient falls on geriatric rehabilitation units in a hospital.MethodsThe falls recorded in the geriatric rehabilitation units between January 2006 and December 2008 were reviewed to establish their rates (falls\\/1000 patient days) and locations.
Edgar Ramos Vieira; Colleen Berean; Debra Paches; Larissa Costa; Natacha Décombas-Deschamps; Penny Caveny; Doris Yuen; Lauralee Ballash
Competency-based education prepares trainees to perform tasks occurring within the context of practice. There are currently no geriatrics-specific, competency-based consensus performance standards for medical students. The authors present the results of a systematic, multimethod process to identify and define the minimum geriatrics-specific competencies needed by a new intern to adequately care for older adults. An alpha draft was crafted by
Rosanne M. Leipzig; Lisa Granville; Deborah Simpson; M Brownell Anderson; Karen Sauvigné; Rainier P. Soriano
Medical educators have a responsibility to teach students to communicate effectively, yet ways to accomplish this are not well-defined. Sixty-five percent of medical schools teach communication skills, usually in the preclinical years; however, communication skills learned in the preclinical years may decline by graduation. To address these problems the New York University School of Medicine, Case Western Reserve University School
Adina Kalet; Michele P. Pugnaire; Kathy Cole-Kelly; Regina Janicik; Emily Ferrara; Mark D. Schwartz; Mack Lipkin Jr.; Aaron Lazare
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…
Rejeski, W. Jack
premature ventricular contractions per minute on his ECG which is otherwise normal. His blood pressure to life IV 4% (n= 256)Severe Systemic dis., Causing funct. Limit III 0.5% (n=187)Mild systemic dis/heparin Â· Low molecular wt heparin #12;Risk of Postoperative DVT/PE Age 40 yrs Surgery
Mootha, Vamsi K.
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
Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.
The prevalence of Helicobacter pylori (H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal (GI) malignancies, upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore, “endoscopy and treat” strategy may be more appropriate instead of “test and treat” strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication, except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however, the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be considered before starting the treatment. This paper reviews briefly the epidemiology, diagnosis, disease manifestations, and treatment options of H. pylori in the geriatric population. PMID:25133042
Cizginer, Sevdenur; Ordulu, Zehra; Kadayifci, Abdurrahman
The aim of the study was to identify nurses’ ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic. Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy, beneficence, non-maleficence, and justice. A Grounded Theory methodology was used. In total, 65 observations and follow-up interviews with 20 nurses were conducted, and data were analysed by constant comparative analysis. Three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category: “Corroborating.” In corroborating, the focus is on the person in need of integrity and self-determination; that is, the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e., to benefit someone); nurses must also connect and care for the older person (i.e., demonstrate non-maleficence) in order to corroborate that person. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy, beneficence, and non-maleficence. The principal of justice was not specifically identified as a visible nursing action. However, all older patients received treatment, care, and reception in an equivalent manner. PMID:21931577
Jonasson, Lise-Lotte; Liss, Per-Erik; Westerlind, Bjorn; Bertero, Carina
Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide being more prevalent in old age. The present survey of hypertensive patients fulfilling the standard diagnostic criteria of WHO/ISH (2004) is carried out in geriatric age group from the Saurashtra region of Gujarat in India to observe the dietary pattern and provocative factors. Total 120 patients of 50 to 80 years of age having systolic blood pressure >140 mm Hg and ?180 mm Hg and diastolic blood pressure >90 mm Hg and ?110 mm Hg irrespective of gender and religion were selected for the present study. They were interviewed for list of provocative factors enlisted in Ayurveda. As observed, the study supported the facts described in Ayurveda that dietary etiological factors, such as excess intake of Lavana (salty), Amla (sour), Katu (pungent), Tikshna, Ushna (hot), Vidahi (producing burning sensation), Viruddha (incompatible), Snigdha (unctuous), Abhishyandi (leading to obstruction), Madhura (sweet), Guru (heavy to digest) dietary articles, Ajirnashana (taking diet before complete digestion of previous meal), Adhyashana (repeated eating at short intervals), will vitiate Rakta dhatu as well as Pitta dosha in the body leading to disorders like hypertension. Hypertension in old age is found to be a disease of Vata-Pitta dominant vitiation with the involvement of Rasa, Rakta, Meda as main Dushya (vitiated factors) and dietary factors can contribute to worsening of the disease. The etiological factors having role in the pathogenesis can also be applied for preventive guidelines for the management of hypertension. PMID:23723671
Jagtap, Madhavi V.; Deole, Yogesh S.; Chandola, Harimohan; Ravishankar, B.
Aging population is set to increase in the near future, and will need specialized care when admitted to ICUs. The elderly are beset with chronic conditions, such as cardiovascular, COPD, diabetes, renal complications and depression. Specialist opinions can now be made available through telemedicine facilities. Tele-ICU is a specialized hub consisting of highly skilled staff trained in critical care able to deliver timely, quality care service to patients admitted to ICUs in remote areas using highly advanced information technology services. These specialists in the tele-ICU hub are able to analyze and gather data arriving at timely interventional management decisions and provide this vital feedback to the nursing staff and doctors manning remote ICU locations where specialized intensivist may not be available. Known clinical benefits of such a system include better patient outcomes, reduced medical errors, mortality and reduced hospital length of stay. The main disadvantage in implementation could be the upfront high cost involved, for which low-cost models are being explored. In the face of delivering such remote care, it is up to the local health policy to make legislative changes to include associated legal and ethical issues. Considering the burgeoning aging population, tele-ICU could become the way forward in delivering geriatric critical care. PMID:24803284
Hao, Jun-Feng; Cui, Han-Min; Han, Jing-Ming; Bai, Jiu-Xu; Song, Xiaohua; Cao, Ning
The prevalence of Helicobacter pylori (H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal (GI) malignancies, upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore, "endoscopy and treat" strategy may be more appropriate instead of "test and treat" strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication, except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however, the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be considered before starting the treatment. This paper reviews briefly the epidemiology, diagnosis, disease manifestations, and treatment options of H. pylori in the geriatric population. PMID:25133042
Cizginer, Sevdenur; Ordulu, Zehra; Kadayifci, Abdurrahman
To identify ways to improve cancer care for older patients, we set out to examine how older patients in the Netherlands are currently being evaluated prior to oncological treatment and to explore the potential obstacles in the incorporation of a geriatric evaluation, using a web-based survey sent to Dutch medical oncology specialists and oncology nursing specialists. The response rate was 34% (183 out of 544). Two-thirds of respondents reported that a geriatric evaluation was being used, although primarily on an ad hoc basis only. Most respondents expressed a desire for a routine evaluation or more intensive collaboration with the geriatrician and 86% of respondents who were not using a geriatric evaluation expressed their interest to do so. The most important obstacles were a lack of time or personnel and insufficient availability of a geriatrician to perform the assessment. Thus, over 30% of oncology professionals in the Netherlands express an interest in geriatric oncology. Important obstacles to a routine implementation of a geriatric evaluation are a lack of time, or insufficient availability of geriatricians; this could be overcome with policies that acknowledge that quality cancer care for older patients requires the investment of time and personnel. PMID:24702775
Jonker, J M; Smorenburg, C H; Schiphorst, A H; van Rixtel, B; Portielje, J E A; Hamaker, M E
The basic concept of integrative medicine (IM) is that by combining mainstream (biomedicine) with complementary and alternative medicine (CAM), synergistic therapeutic effects can be attained. When the methods of mind/body medicine (MBM) are added to this combination, as in Western countries, a new concept emerges that drastically changes the approach toward illness.It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples' Republic of China preceded the Western model of IM by almost 50 years. Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM, and Chinese medicine has played and continues to play an important role in advancing IM. However, one of the major differences between the Chinese and the Western models of IM today, besides MBM and some other treatment options, is that Western integrative medicine (WIM) strictly requires its CAM methods to be supported by scientific evidence.The therapeutic methods of IM and their applications are many and varied. However, they are most frequently employed to treat chronic medical conditions, e.g., bronchial asthma, rheumatic disease, chronic inflammatory bowel disorder and chronic pain. Other fields in which IM may be applied are internal medicine (inflammatory bowel diseases and cardiovascular diseases), musculoskeletal disorders, oncology (chemotherapy-induced side effects), obstetrics and gynecology (dysmenorrhea, endometriosis, infertility and menopausal complaints), pediatrics, geriatrics, neurology (migraine and chronic headache), and psychiatry (anxiety and depression).The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM. PMID:21258891
Dobos, Gustav; Tao, Iven
Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in
Patrizia Mecocci; Eva von Strauss; Antonio Cherubini; Sara Ercolani; Elena Mariani; Umberto Senin; Bengt Winblad; Laura Fratiglioni
Conventional risk assessment practices utilize a tenfold uncertainty factor (UF) to extrapolate from the general human population to sensitive subgroups, such as children and geriatrics. This study evaluated whether the tenfold UF can be reduced when pharmacokinetic and pharmacodynamic data for pharmaceuticals used by children and geriatrics are incorporated into the risk assessment for human sensitivity. Composite factors (kinetics X
Gloria A. Skowronski; Mohamed S. Abdel-Rahman
Geriatrics as a field has been fortunate to have the support of several philanthropic organizations to advance geriatrics education and training in the past two decades. Awardees of such grants were presented with unparalleled opportunities to develop new and innovative educational initiatives affecting learners at multiple levels and in multiple disciplines and specialties. The lessons learned from the Donald W. Reynolds Foundation initiatives about effect and sustainability are invaluable to the ongoing strategic development of geriatrics nationally. This article highlights successful educational initiatives developed at four institutions with past and current Donald W. Reynolds Foundation funding. Following an ice hockey playbook, this article identifies 10 strategies and initiatives to "stay in the geriatrics game" by training hospitalists and subspecialty providers. The authors' collective experience suggests that geriatrics educational initiatives can not only influence provider education, but also improve the care of older adults in multiple settings. PMID:25040491
Gillespie, Suzanne M; Brandt, Lynsey E; Chang, Anna; Chao, Serena H; Corcoran, Amy M; Miller, Rachel; Harper, G Michael; Levine, Sharon A; Medina-Walpole, Annette
Background Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, “concurrent use of five or more different prescription medication”. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. Methods A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age ?65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. Results The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. Conclusion The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern. PMID:25402452
Mujeeb, Rakshinda; Patel, Muhammad Junaid
In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a 'good death' through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric 'train-the-trainer' project was launched in 2007 to increase the knowledge and educational skills of nurses and unlicensed staff providing end-of-life care for older adults in nursing homes, skilled nursing facilities, long-term care, and hospices. From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum. PMID:21537321
Kelly, Kathe; Thrane, Susan; Virani, Rose; Malloy, Pam; Ferrell, Betty
Introduction: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a vertebral fracture. Methods: This study is a retrospective cohort study, which included all patients with an age of 65 years and older, who were diagnosed with a vertebral fracture and where therefore admitted to the Geriatric Fracture Center over a period of 2 years. Primary outcome was the level of functioning 6 weeks and 3 months after admission. Results: We included 106 patients with 143 vertebral fractures, of which 61 patients were evaluated after 3 months. In our population, 53% of the patients had a fracture involving both middle and anterior columns. The majority of the patients functioned sufficiently 6 weeks and 3 months after admission. Analysis showed that age <80 years is an independent predictor of a sufficient level of functioning after 6 weeks. Discussion: The nonoperative treatment of elderly patients with a vertebral fracture leads to a sufficient level of functioning 6 weeks and 3 months after admission. In our population, only age <80 years is an independent predictor for a sufficient level of functioning 6 weeks after admission. The level of functioning at 6 weeks predicts the level of functioning 3 months after admission. On comparison, the level of functioning after early ambulation is equal to the level of functioning after immobilization. Where immobilization may lead to complications, early ambulation was not associated with new complications or neurological damage. Based on these advantages, the treatment of elderly patients with a fracture involving both middle and anterior columns may be altered from immobilization to mobilization in the future.
Folbert, E. C.; Kraai, M.; Smit, R. S.; Hegeman, J. H.; van der Velde, D.
Background The majority of deaths (90%) attributed to influenza are in person’s age 65 or older. Little is known about whether defects\\u000a in innate immune responses in geriatric individuals contribute to their susceptibility to influenza.\\u000a \\u000a \\u000a \\u000a \\u000a Objective Our aim was to analyze interferon-alpha (IFN-alpha) production in peripheral blood mononuclear cells (PBMCs) isolated from\\u000a young and geriatric adult donors, stimulated with influenza A or
David H. Canaday; Naa Ayele Amponsah; Leola Jones; Daniel J. Tisch; Thomas R. Hornick; Lakshmi Ramachandra
Expedition and wildeness medicine is a term that combines rescue medicine, sport medicine as well as more specific branches as polar or high altitude medicine. It is being intensively studied both at the reaserch institutes and on expeditions. Ophtalmologists are concentrated on the reaserch of HARH (High Altitude Retinal Hemorrhage), neurologists on HACE reaserch (High Altitude Cerebral Edema), psychologists are developing tests to decsribe cognitive functions and many physicians are being trained to work in extreme enviroment. The result of all this effort are numerous new findings in pathophysiology and therapy of altitude illness, increased security on expedition and further development of expeditionism. PMID:23120871
2007--2008 Faculty of Medicine Graduate School of Medicine PROSPECTUS The University of Tokyo #12;#12;Welcome to Faculty of Medicine, Graduate School of Medicine The University of Tokyo Takao Shimizu Dean, Faculty of Medicine, Graduate School of Medicine The University of Tokyo The Faculty of Medicine
...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general practice...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general...
...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general practice...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general...
...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general practice...general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic general...
Bandura's social learning theory provides a useful conceptual framework to understand medical students' perceptions of a house calls experience at Virginia Commonwealth University School of Medicine. Social learning and role modeling reflect Liaison Committee on Medical Education guidelines for "Medical schools (to) ensure that the learning…
Abbey, Linda; Willett, Rita; Selby-Penczak, Rachel; McKnight, Roberta
Background. Awareness of the use of geriatric assessments for older patients with cancer is increasing. The aim of this review is to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes. Method. A systematic search was conducted in Medline and Embase of studies on geriatric assessment in oncology, focusing on the association between baseline assessment and outcome. Results. The literature search identified 2008 reports; 51 publications from 37 studies were selected for inclusion in the review. The quality of studies was heterogeneous and generally poor. A median of five geriatric conditions were assessed per study (interquartile range: 4–8). Little consistency was found in the results of the studies. Furthermore, different tools appear to be predictive depending on the outcome measure: frailty, nutritional status, and comorbidity assessed by the Cumulative Illness Rating Scale for Geriatrics were predictive for all-cause mortality; frailty was predictive for toxicity of chemotherapy; cognitive impairment and activities of daily living impairment were predictive for chemotherapy completion; and instrumental activities of daily living impairment was predictive for perioperative complications. Conclusion. Although various geriatric conditions appear to be of some value in predicting outcome in elderly patients with cancer, the results are too inconsistent to guide treatment decisions. Further research is needed to elucidate the role of geriatric assessments in the oncologic decision-making process for these patients. PMID:22941970
Vos, Alinda G.; Smorenburg, Carolien H.; de Rooij, Sophia E.; van Munster, Barbara C.
Despite the increasing public demand for enhanced care of older patients and those with life-threatening illness, health professionals have had limited formal education in geriatrics and palliative care. Furthermore, formal education in interdisciplinary team training is limited. In order to remedy this situation, proactive interventions are being…
Howe, Judith L.; Sherman, Deborah Witt
An educational program on geriatric foot care was completed by 59 nurse practitioners, 12 physicians' assistants, and 1 physician. The 3 1/2 day program included interactive sessions, observation, and hands-on patient care. Posttest results and 6-month follow-up showed significant knowledge increases and incorporation of learning into practice.…
Suggs, Patricia K.; Krissak, Ruth; Caruso, Frank; Teasdall, Robert
An interdisciplinary geriatrics team training institute focused on cutting-edge health care themes had 30 participants. Qualitative and quantitative evaluation showed that participants sought specific, work-applicable insights; the focus on new approaches was critical; and careful attention to educational program marketing was needed. (SK)
Clark, Phillip G.
This study examined the validity of Geriatric Depression Scale--5 (GDS-5) scores among older sedentary adults based on its structural properties and relationship with external criteria. Participants from two samples (Ns = 185 and 93; M ages = 66 and 67 years) completed baseline assessments as part of randomized controlled exercise trials.…
Marquez, David X.; McAuley, Edward; Motl, Robert W.; Elavsky, Steriani; Konopack, James F.; Jerome, Gerald J.; Kramer, Arthur F.
Anchored on the key constucts of Ajzen's Theory of Planned Behavior (1985), this paper seeks to test a model that explores the influence of knowledge, attitude, and caring behavior on nursing students' behavioral intention toward geriatric care. A five-part survey-questionnaire was administered to 839 third and fourth year nursing students from a…
de Guzman, Allan B.; Jimenez, Benito Christian B.; Jocson, Kathlyn P.; Junio, Aileen R.; Junio, Drazen E.; Jurado, Jasper Benjamin N.; Justiniano, Angela Bianca F.
Background. Knowledge of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization, and the frequency of transmission is vital for the implementation of MRSA infection control measures in hospitals. We assessed risk factors for and rates of colonization of MRSA upon admission to a geriatric rehabilitation hospital, and studied the contribution of the colonization on hospital mortality. Methods. This was a
Efraim Aizen; Zlata Ljubuncic; Predrag Ljubuncic; Ira Aizen; Israel Potasman
This study describes the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium. In 2002 (the year Belgium voted a law on euthanasia), a structured mail questionnaire was sent to all head geriatricians of acute geriatric wards in Flanders (N=94). Respondents were asked about the existence, development, and implementation of the DNR policy (guidelines and order forms). The response was 76.6%. Development of DNR policy began in 1985, with a step-up in 1997 and 200l. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions. PMID:18074753
De Gendt, C; Bilsen, J; Vander Stichele, R; Lambert, M; Van Den Noortgate, N; Deliens, L
Background: Gender bias has been reported in the diagnosis and treatment of patients with a variety of illnesses. In the context of our 10-station fourth year Objective Structured Clinical Evaluation, we queried whether this could influence diagnosis in a geriatric case. Case writers hypothesized that, due to this bias, the female standardized…
Lewis, Roya; Lamdan, Ruth M.; Wald, David; Curtis, Michael
Virtual worlds could offer inexpensive and safe three-dimensional environments in which medical trainees can learn to identify home safety hazards. Our aim was to evaluate the feasibility, usability, and acceptability of virtual worlds for geriatric home safety assessments and to correlate performance efficiency in hazard identification with…
Andrade, Allen D.; Cifuentes, Pedro; Mintzer, Michael J.; Roos, Bernard A.; Anam, Ramanakumar; Ruiz, Jorge G.
Chlordimeform (CDM), a formamidine pesticide, had a profound effect on the cardiovascular function of geriatric rats. Two-year-old pentobarbital-anesthetized Sprague-Dawley rats (n=8) received sequential intravenous CDM injections of 5, 10, 30, and 60 mg/kg. A control group of ra...
We redesigned our medical school's Problem-Based Learning (PBL) curriculum to include a substantial increase in required geriatrics content. Innovations included new PBL health care problems and standardized patients (SPs) throughout the first three years and a new required four-week, fourth-year rotation. We used data from the AAMC Medical School…
Nagoshi, Michael H.; Tanabe, Marianne K. G.; Sakai, Damon H.; Masaki, Kamal H.; Kasuya, Richard T.; Blanchette, Patricia L.
Elderly persons (N=310) attending outpatient psychiatric clinics were given an interview on the 30-item Geriatric Depression Scale (T. L. Brink et al., 1982; J. A. Yesavage et al., 1983) and received an independent psychiatric evaluation. A 3-step binary logistic regression showed that 2 items measuring positive affect and 2 others measuring…
Cheng, Sheung-Tak; Chan, Alfred C. M.
Evaluated hopelessness, depression, and self-esteem among depressed elderly people (N=78) and developed a Geriatric Hopelessness Scale (GHS). As predicted, elderly subjects who scored high on the GHS showed significantly higher depression and lower self-esteem scores. (JAC)
Fry, P. S.
An overview is presented of several areas of deprivation research (animal, child, young adult) and methods of conceptualizing and measuring deprivation is applied to institutionalized geriatric patients. Suggestions are made for more precise approaches to studying and treating deprivation in this population. (Author/SS)
Erber, Joan T.
The aim of this research was to indicate the necessity of a new organizational model of health and social care system for the geriatric population in Croatia. Modern geriatrics puts special emphasis on the idea that the care of the elderly should be performed through home care or long-term care institutions, rather than in the acute care hospital departments. The social healthcare of the elderly requires a multidisciplinary approach, as well as teamwork and coordination of institutional and non-institutional departments. Founding of palliative care units is clearly absent from the existing elderly care system. 33% of the total deceased geriatric population within the target area (2000-2002) has passed away in institutions (Dubrovnik General Hospital and nursing homes), what clearly indicates a need for organized palliative care on the stationary level. Nursing homes in Croatia should accept about 4% of the total number of older population (according to the gerontology research). Nevertheless, this research shows that the available capacity of the nursing homes in the Dubrovansko-Neretvanska County is 50% of the projected percentage. The solution might be setting up of palliative-geriatric units in already existing institutions, as shown by the SWOT analysis. PMID:16117336
In 2000, the Senior Mentor Program was implemented as an innovative, instructional method in the University of South Carolina's medical school curriculum designed to enhance and strengthen student training in geriatrics. This study qualitatively analyzed second-year medical students' and senior participants' perceptions of and attitudes towards…
Corwin, Sara J.; Frahm, Kathryn; Ochs, Leslie A.; Rheaume, Carol E.; Roberts, Ellen; Eleazer, G. Paul
In 2000, the Senior Mentor Program was implemented as an innovative, instructional method in the University of South Carolina's medical school curriculum designed to enhance and strengthen student training in geriatrics. This study qualitatively analyzed second-year medical students' and senior participants' perceptions of and attitudes towards the Senior Mentor Program as an effective learning modality. A total of 36 second-year
Sara J. Corwin; Kathryn Frahm; Leslie A. Ochs; Carol E. Rheaume; Ellen Roberts; G. Paul Eleazer
This study examined first-year medical student attitudes concerning the elderly before and after instituting a geriatric mentoring program. The program began and ended with a survey designed to assess students' attitudes toward the elderly. During the mentoring program, students visited the same senior for four visits throughout the academic year.…
Duke, Pamela; Cohen, Diane; Novack, Dennis
Am J Geriatr Psychiatry . Author manuscript Page /1 10 Insomnia symptoms in older email@example.com > Abstract Objectives The aim of this study was to examine the factors associated with insomnia in community-dwelling elderly as a function of the nature and number of insomnia symptoms (IS) . difficulty with initiating
Paris-Sud XI, UniversitÃ© de
Background & objectives: Sleep in older persons is characterized by decreased ability to stay asleep, resulting in fragmented sleep and reduced daytime alertness. Pharmacological treatment of insomnia in older persons is associated with hazardous side effects. Hence, the present study was designed to compare the effects of Yoga and Ayurveda on the self rated sleep in a geriatric population. Methods:
N. K. Manjunath; Shirley Telles
This final report documents the development of a workplace literacy program for 100 employees of the Geriatric Authority of Holyoke, Massachusetts (GAH), a major nonprofit nursing home and rehabilitation facility. It describes how GAH employees received instruction in English as a Second Language, adult basic education, and General Educational…
Massachusetts Career Development Inst., Springfield.
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a…
Gomez, Fernando; Curcio, Carmen Lucia
Given the increasingly aging population, nearly every doctor will encounter elderly adults who present with multiple complex comorbidities that can challenge even experienced physicians. This may explain why many medical students do not have a positive attitude toward elderly adults and find the complexity of their problems overwhelming. It was hypothesized that a recently developed medical school geriatrics course, based on the game GeriatriX and designed specifically to address the complexities associated with decision-making in geriatrics, can have a positive effect on attitudes toward geriatrics and on perceived knowledge of geriatrics. The effects of this game-based course were evaluated as a proof of concept. The assessment was based on the Aging Semantic Differential (ASD) and a validated self-perceived knowledge scale of geriatric topics. The usability of (and satisfaction with) GeriatriX was also assessed using a 5-point Likert scale. After completion of the course, the ASD changed significantly in the geriatrics course group (n = 29; P = .02) but not in a control group that took a neuroscience course (n = 24; P = .30). Moreover, the geriatrics course group had a significant increase in self-perceived knowledge for 12 of the 18 topics (P = .002), whereas in the control group self-perceived knowledge increased significantly for one topic only (sensory impairment) (P = .04). Finally, the geriatrics students reported enjoying GeriatriX. This proof-of-concept study clearly supports the hypothesis that a 4-week course using a modern educational approach such as GeriatriX can improve students' self-perceived knowledge of geriatrics and their attitudes toward elderly adults. PMID:25283695
van de Pol, Marjolein H J; Lagro, Joep; Fluit, Lia R M G; Lagro-Janssen, Toine L M; Olde Rikkert, Marcel G M
A recent report in the journal Pediatrics questioned the effectiveness of over-the-counter children's cough medicines. In this Science Update, you'll hear more about the study, and why some medicines may have escaped this sort of rigorous testing.
In "Narrative Medicine: Honoring the Stories of Illness," Rita Charon paints an original and humane portrait of what it can mean to be a doctor, to live a life immersed in sickness and dedicated to wellness. Charon drops the veil, inviting readers to look at the secret, subjective, emotional face of medicine, a zone of self-censored feelings and…
Bochner, Arthur P.
Objective To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency. Search strategy We searched the EPOC Register, Cochrane’s Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals. Selection criteria Randomised controlled trials of comprehensive geriatric assessment (whether by mobile teams or in designated wards) compared with usual care. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process used to determine the medical, psychological, and functional capabilities of a frail elderly person to develop a coordinated and integrated plan for treatment and long term follow-up. Data collection and analysis Three independent reviewers assessed eligibility and trial quality and extracted published data. Two additional reviewers moderated. Results Twenty two trials evaluating 10?315 participants in six countries were identified. For the primary outcome “living at home,” patients who underwent comprehensive geriatric assessment were more likely to be alive and in their own homes at the end of scheduled follow-up (odds ratio 1.16 (95% confidence interval 1.05 to 1.28; P=0.003; number needed to treat 33) at a median follow-up of 12 months versus 1.25 (1.11 to 1.42; P<0.001; number needed to treat 17) at a median follow-up of six months) compared with patients who received general medical care. In addition, patients were less likely to be living in residential care (0.78, 0.69 to 0.88; P<0.001). Subgroup interaction suggested differences between the subgroups “wards” and “teams” in favour of wards. Patients were also less likely to die or experience deterioration (0.76, 0.64 to 0.90; P=0.001) and were more likely to experience improved cognition (standardised mean difference 0.08, 0.01 to 0.15; P=0.02) in the comprehensive geriatric assessment group. Conclusions Comprehensive geriatric assessment increases patients’ likelihood of being alive and in their own homes after an emergency admission to hospital. This seems to be especially true for trials of wards designated for comprehensive geriatric assessment and is associated with a potential cost reduction compared with general medical care. PMID:22034146
The main aim of this study was to determine the medication errors among geriatrics at the outpatient pharmacy in a teaching hospital in Kelantan and the strategies to minimize the prevalence. A retrospective study was conducted that involved screening of prescription for a one-month period (March 2001). Only 15.35% (1601 prescription) of a total 10,429 prescriptions were for geriatrics. The prescriptions that were found to have medication errors was 403. Therefore, the prevalence of medication errors per day was approximately 20 cases. Generally, the errors between both genders were found to be comparable and to be the highest for Malays and at the age of 60–64 years old. Administrative errors was recorded to be the highest which included patient’s particulars and validity of the prescriptions (70.22%) and drugs that available in HUSM (16.13%). Whereas the total of prescribing errors were low. Under prescribing errors were pharmaceutical error (0.99%) and clinical error (8.68%). Sixteen cases or 3.98% had more than 1 error. The highest prevalence went to geriatrics who received more than nine drugs (32.16%), geriatrics with more than 3 clinical diagnosis (10.06%), geriatrics who visited specialist clinics (37.52%) and treated by the specialists (31.07%). The estimated cost for the 403 medication errors in March was RM9,327 or RM301 per day that included the cost of drugs and humanistic cost. The projected cost of medication errors per year was RM 111,924. In conclusion, it is very clear that the role of pharmacist is very great in preventing and minimizing the medication errors beside the needs of correct prescription writing and other strategies by all of the heath care components. PMID:22973127
Abdullah, Dellemin Che; Ibrahim, Noor Shufiza; Ibrahim, Mohamed Izham Mohamed
Treatment of elderly patients with breast cancer is limited by the lack of evidence-based medicine due to exclusion of elderly\\u000a persons from clinical studies and the difficulty of decision-making in an elderly population comprising subjects with heterogeneous\\u000a health backgrounds. Individual variation of health conditions is larger in elderly patients than in young people. Since the\\u000a risk–benefit balance of treatment depends
Naruto Taira; Masataka Sawaki; Miyako Takahashi; Kojiro Shimozuma; Yasuo Ohashi
BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
Sward, Douglas G.; Bennett, Brad L.
Background Older patients are at high risk for poor outcomes after acute hospital admission. The mortality rate in these patients is approximately 20%, whereas 30% of the survivors decline in their level of activities of daily living (ADL) functioning three months after hospital discharge. Most diseases and geriatric conditions that contribute to poor outcomes could be subject to pro-active intervention; not only during hospitalization, but also after discharge. This paper presents the design of a randomised controlled clinical trial concerning the effect of a pro-active, multi-component, nurse-led transitional care program following patients for six months after hospital admission. Methods/Design Three hospitals in the Netherlands will participate in the multi-centre, double-blind, randomised clinical trial comparing a pro-active multi-component nurse-led transitional care program to usual care after discharge. All patients acutely admitted to the Department of Internal Medicine who are 65 years and older, hospitalised for at least 48 hours and are at risk for functional decline are invited to participate in the study. All patients will receive integrated geriatric care by a geriatric consultation team during hospital admission. Randomization, which will be stratified by study site and cognitive impairment, will be conducted during admission. The intervention group will receive the transitional care bridge program, consisting of a handover moment with a community care Care Nurse (CN) during hospital admission and five home visits after discharge. The control group will receive 'care as usual' after discharge. The main outcome is the level of ADL functioning six months after discharge compared to premorbid functioning measured with the Katz ADL index. Secondary outcomes include; survival, cognitive functioning, quality of life, and health care utilization, satisfaction of the patient and primary care giver with the transitional care bridge program. All outcomes will be measured at three, six and twelve months after discharge. Approximately 674 patients will be enrolled to either the intervention or control group. Discussion The study will provide new knowledge on a combined intervention of integrated care during hospital admission, a proactive handover moment before discharge and intensive home visits after discharge. Trial registration Trial registration number: NTR 2384 PMID:21034479
The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care. PMID:9584661
Spiegel, D; Stroud, P; Fyfe, A
2005--2006 Faculty of Medicine Graduate School of Medicine PROSPECTUS The University of Tokyo #12;#12;Welcome to Faculty of Medicine, Graduate School of Medicine The University of Tokyo Nobutaka Hirokawa Dean, Faculty of Medicine, Graduate School of Medicine The University of Tokyo The University of Tokyo Graduate
Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results. Methods A convenience sample of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for individual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values<0.05 were considered as statistically significant. Results Time required for completion of the SGA by 90% of the study population was 20min and 40s. This represents approximately 8.6% of new 4-h ED targets. Secondary characteristics that affected the time taken for screening included patients from non-English-speaking backgrounds (P<0.05). Conclusions Use of the SGA for intra-ED geriatric risk stratification is feasible and practical in the time-critical National Emergency Access Target (NEAT) environment. The relatively short amount of time used for screening this vulnerable demographic has implications for interdisciplinary management and potentially represents an efficient intervention to reduce future re-presentations and overcrowding in Australian EDs. Future high-quality trials are required to assess the clinical benefit of the SGA. What is known about the topic? The newly introduced ED NEAT encourages patient discharge from ED within 4h of arrival, placing increased pressure on ED protocols to be time efficient, while still maintaining safe quality care. The Comprehensive Geriatric Assessment in inpatient and ED settings has demonstrated improved outcomes in populations aged>65, including parameters of ED re-presentations, functional independence and short-term mortality. Geriatric emergency patient guidelines have been recently adopted in the US and UK which incorporate intra-ED geriatric screening processes. Studies focusing on the feasibility of geriatric screening in Australian EDs are scarce. What does this paper add? Our pilot study focuses on the timing requirements of geriatric screening in time-critical ED environments. We analysed the time taken to conduct a SGA that was developed for a large research project, and the secondary patient characteristics that affected these times. Our paper provides valuable information for Australian EDs when considering the introduction of geriatric screening into EDs to optimise the care and outcomes of this patient group. Analysis of secondary patient characteristics and data patterns will further help EDs and future research into design of new protocols. What are the implications for practitioners? The results of our pilot study suggest that use of the SGA in Australian ED settings is feasible and practical. By using the results of our pilot study, EDs and clinician researchers can make informed decisions about implementation of new protocol to manage older patients. We suggest that implementation of intra-ED geriatric screening assessments will result in improved patient outcomes, including long-term functional independence and decreased rates of ED re-presentation. This in turn would help to unclog our currently overloaded EDs. PMID:25055343
Nguyen, Alan; Straney, Lahn; Cameron, Peter; Lowthian, Judy
J Am Geriatr Soc . Author manuscript Page /1 11 Disability and incident coronary heart disease associated with prevalent coronary heart disease (CHD) and with shorter longevity. However, whether ; disability ; coronary heart disease ; atherosclerosis. #12;Disability and coronary heart disease
Broadcast Transcript: Japanese gardens are admired for their understated elegance, their meditation/movement fusion, their precise placement of essential elements such as water and stone. In this last way at least, Medicinal Herbman is typically...
Contents: Summary of forensic medicine; Life reactions; Necrosis and necrotic phenomena; Causes of death and violent deaths; Mechanical injuries; Poisoning and tests for poisons; Mechanical suffocation; Injury and death from burns and scalds; Electrocutio...
Medical school entrance depends on passing a central examination that is given annually by the National Selection and Placement Center. Undergraduate medical education takes 6 years. About 5000 students graduate from medical faculties annually. The central exam necessary for residency training is given by the National Selection and Placement Center. A Specialist Training Regulation regulates residency training. Internal medicine residency training takes 4 years and includes inpatient and outpatient care in wards and rotations. Residents prepare a dissertation that is used in the evaluation of residency competency. At the end of the residency period, residents who have been successful in previous evaluations take an oral exam followed by a written exam, which lead to their certification in internal medicine. Residents' scientific knowledge and skills are assessed by a jury consisting of five people, four from the same department and one from the equivalent department in another training institution. The title of specialist is granted after a certification exam given by training institutions and approved by the Ministry of Health. Internists are mainly employed in state hospitals, which are under the Ministry of Health. Subspecialty areas in internal medicine include gastroenterology, geriatrics, endocrinology, nephrology, hematology, rheumatology, immunology, allergology, and oncology. The training period for a subspecialty is 2 years. A substantial effort is being made all over the country to improve regulations and health care service delivery. These changes will also affect the residency training and manpower planning and employment of internists. PMID:16314242
Sahin, Hatice; Akcicek, Fehmi
Introduction Constipation is a common problem in the elderly population, especially in geriatric wards. Laxatives are the most preferred\\u000a solution but current studies link constipation and laxative use to weight-loss and malnutrition in nursing homes. Dietary\\u000a fibers also affect stool weight and transit time. So, oat-bran effectiveness in reducing the need for bowel medication and\\u000a weight-loss for geriatric care patients was
B. Sturtzel; C. Mikulits; C. Gisinger; I. Elmadfa
Background Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric\\u000a health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact\\u000a of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still\\u000a low in
M. Rothan-Tondeur; Y. Filali-Zegzouti; J.-L. Golmard; B. De Wazieres; F. Piette; F. Carrat; B. Lejeune; Gaëtan Gavazzi
Background Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric\\u000a health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact\\u000a of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still\\u000a low in
M. Rothan-Tondeur; Y. Filali-Zegzouti; J.-L. Golmard; B. De Wazieres; F. Piette; F. Carrat; B. Lejeune; Gaëtan Gavazzi
Among the elderly most infections are caused by organisms of faecal origin. The study of the resistance of such Gram-negative bacilli should therefore be a priority. In this study, we determine the occurrence of resistance to five antimicrobials commonly used in geriatric outpatient care, and compare it with long-term and short-term hospitalized geriatric patients treated and not treated with antimicrobials. PMID:8647760
Leistevuo, T; Osterblad, M; Toivonen, P; Kahra, A; Lehtonen, A; Huovinen, P
The ageing population is an important public health issue for our health system which is poorly adapted for this group because it is conceived primarily for managing acute issues and not as prepared for dealing with chronic disease. Elderly people require continuous care, including attention to geographic proximity of services and a holistic approach to care. Appropriate geriatric care necessitates the active contribution of all health actors including prevention and re-adaptation. This kind of organisation of work must incorporate an adequate delineation of the health territory and a corresponding plan in which all responses are readily available and accessible. We propose the application of geriatric managed care through the implementation of the third generation of the national health plan to respond to this issue. This experience at the regional level is described and outlined, as well as the relevant reflections and learning outcomes that can be extracted. PMID:20218413
Defebvre, Marguerite-Marie; Schapiro, Johanna
Hyperkalemia is a potentially life-threatening electrolyte imbalance that can be difficult to diagnose due to the paucity of specific signs and symptoms. Because hyperkalemia can lead to sudden death from cardiac arrhythmias and asystole, any patient whose history, physical examination or laboratory studies raise clinical suspicion of hyperkalemia requires an immediate 12-lead electrocardiogram to ascertain whether electrocardiographic manifestations of electrolyte imbalance are present. The current report describes a case involving an elderly man who developed hyperkalemia secondary to acute-on-chronic kidney injury. Factors affecting the vulnerability of geriatric patients to hyperkalemia, the electrocardiographic manifestations of elevated serum potassium levels, and the importance of timely recognition and management are discussed. Understanding the factors that contribute to hyperkalemia, timely recognition of electrocardiogram changes and timely initiation of appropriate therapy are all critical in the approach to hyperkalemia in the geriatric patient. PMID:21747664
McIntyre, William F; Femenia, Francisco; Arce, Mauricio; Perez-Riera, Andres Ricardo; Baranchuk, Adrian
Considering the worldwide ageing of populations, there is a growing need for rehabilitation programmes specifically designed for geriatric patients. The authors developed and implemented a post-acute geriatric rehabilitation programme in a skilled nursing facility for patients with advanced chronic obstructive pulmonary disease (COPD)-the GR-COPD programme. This paper describes the characteristics of the programme and presents three case studies to illustrate its possible benefits for individual patients. The case studies show that integration of rehabilitation and palliative care components is essential, as patients with advanced COPD admitted to hospital for an acute exacerbation often suffer from high symptom burden, deteriorating quality of life, and poor prognosis. Development and implementation of a post-acute GR-COPD programme is feasible and can offer substantial benefits for patients with advanced COPD admitted to hospital for an acute exacerbation. PMID:23665572
van Dam van Isselt, Eléonore F; Groenewegen-Sipkema, Karin H; Spruit-van Eijk, Monica; Chavannes, Niels H; Achterberg, Wilco P
The PEN&PAD (Geriatrics) project seeks to develop a Collaborative Patient Record System for the hospital based shared care of the elderly. The goal of the project is to produce a single, integrated information system which is both useful and usable by the different practitioner groups involved in geriatric care. A User Centred Design methodology is proposed which makes users and human issues central to the design and development process. Preliminary results indicate that the specification of a Minimum Basic Data Set as the basis of a shared record system is infeasible and undesirable. An architecture is presented which illustrates how the diversity between the different disciplines may be preserved in a Collaborative Patient Record System. PMID:1482857
Heathfield, H.; Kirby, J.; Nowlan, A.; Rector, A.
The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the\\u000a medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The\\u000a purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in
T. J. Luger; C. Kammerlander; M. Gosch; M. F. Luger; U. Kammerlander-Knauer; T. Roth; J. Kreutziger
Increases in the world's older population have posed a significant challenge to available health care resources. For many older people, informal initiatives represent a necessary, rather than an optional health care strategy in the absence of alternatives. Those individuals with the greatest health and economic dependencies are often held responsible for their reliance on subsidized long-term care services. This tendency to blame the victim appears to transcend fundamental philosophic differences which have traditionally distinguished some collectivist and individualist societies. Although health care has been viewed traditionally by health professionals as their domain, self-care and lay initiatives have recently been recognized by professionals as important to the health care of different population groups including older people. The concept of self-care has been used in various ways by different people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self-care in different countries and health care systems. Various influences on the evolution of interest in geriatric self-care were identified including: similarities and differences in health care systems: demographic changes; cohort differences; the emergence of professionals with specialized training in geriatric health care; and, the salience of biomedical models in addressing the health problems of aging. The role of professionals, especially those trained in geriatrics, is examined with an acknowledgment of the importance of a self-care strategy that is independent of professional dominance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3823991
Hickey, T; Dean, K; Holstein, B E
Nutritional status was assessed in 300 geriatric patients aged 75 years or more using clinical, anthropometric, biochemical and immunologic methods. Relations between different assessment methods and their prognostic significance with regard to 18-month mortality were examined. For biochemical variables 10% (prealbumin, vitamin B6) to 37% (vitamins A and C) were below conventional limits. In 44% of the patients lymphocytes were
Dorothee Volkert; Wolfgang Kruse; Peter Oster; Günter Schlierf
There is a growing national awareness that the extraordinary extension of life expectancy in our society poses an impending crisis for our health-care system. This is due in large part to the scarcity of primary-care providers, especially geriatricians. To address these concerns, the Obama administration has considered wide-ranging health-care reforms. Academic geriatric organizations have proposed that geriatricians take the lead
Assessments of older adults with suspected dementia can be time limited and clinicians might consider using abbreviated versions of measures. The present study examined the concurrent validity of abbreviated WAIS-III index scores in a sample of geriatric patients referred for assessment of suspected dementia (N=43; mean age=63.8 years). All 2-subtest estimates of the Verbal Comprehension, Perceptual Organization, and Working Memory
Brian L. Brooks; Linda E. Weaver
of psychosocial, cultural, health literacy, and family data on health 2. Type 2 Diabetes: diagnosis, monitoring, drug management, standards of care, education 3. Systems, treatment, counseling, lifestyle modifications, prognosis 2. Health Systems: communication
Maxwell, Bruce D.
the treatment for the most common inpatient diagnoses including chest pain, arrhythmia, CHF, COPD, PNA, PE/DVT, delirium (altered mental status), acute pain crisis patients understand treatment options. Performance Evals Skills Form Wards
Myers, Lawrence C.
Oncologists need excellent communication skills to effectively handle challenging conversations regarding prognosis, transition to palliative care, code status, and other sensitive topics. Foundational skills include: 1) posing open-ended, exploratory questions, 2) allowing for appropriate silence in the conversation, 3) listening actively, 4) recognizing emotions, 5) responding to emotions with empathy rather than biomedical information, and 6) speaking with clarity by avoiding technical jargon and offering small chunks of information. Conversations about sensitive topics can be particularly challenging with geriatric patients, who experience functional and sensory limitations. The risk-benefit ratio of diagnostic and therapeutic interventions tips precariously in older patients as many develop geriatric syndromes. Older cancer patients have the unique perspective of looking back on a long life and looking forward to impending death. Higher order skills can be very powerful in helping geriatric cancer patients find meaning and dignity at the end of life. These skills include exploring spirituality and coping strategies and engaging the patient in conversation and reflection about their legacy. PMID:24001760
Delgado-Guay, M O; De La Cruz, M G; Epner, D E
Purpose To investigate whether a steam foot spa improves cognitive impairment in geriatric inpatients. Methods Geriatric inpatients with cognitive impairment were given a steam foot spa treatment at 42°C for 20 minutes for 2 weeks (5 days/week). Physiological indicators such as blood pressure, percutaneous oxygen saturation, pulse, tympanic temperature, and sleep time and efficiency were assessed. Cognitive function and behavioral and psychological symptoms of dementia were assessed using the Mini-Mental State Examination, Dementia Mood Assessment Scale, and Dementia Behavior Disturbance scale. Results Significant decreases in systolic (P < 0.01) and diastolic blood pressure (P < 0.05) along with a significant increase in tympanic temperature (P < 0.01) were observed after the steam foot spas. A significant improvement was seen in the Mini-Mental State Examination score (P < 0.01) and the overall dementia severity items in Dementia Mood Assessment Scale (P < 0.05). Limitations Japanese people are very fond of foot baths. However, it is difficult to understand why inpatients cannot receive steam foot baths. In this study, a control group was not used. Raters and enforcers were not blinded. Conclusion The results of this pilot study suggest that steam foot spas mitigate cognitive impairment in geriatric inpatients. PMID:23717038
Koike, Yoshihisa; Kondo, Hideki; Kondo, Satoshi; Takagi, Masayuki; Kano, Yoshio
This article describes the rationale, implementation, interventions and preliminary findings of a Belgian interdisciplinary internal liaison team in a 1470-bed teaching hospital. The motive to start the team was threefold: the ageing of the inhospital population, the conclusion that health care professionals working on non-geriatric wards often lack the necessary skills to deal with older patients' needs and Belgian law, obliging each general hospital to set up an internal liaison team. Our team aims at detecting geriatric patients at risk, assisting health care professionals in caring for older patients and sensitizing them regarding optimal geriatric care. The article explains the underlying philosophy and strategy for implementation, focusing on the concepts of reciprocity, flexibility and cooperation. The preliminary results are based on a process evaluation of 719 consultations carried out from November 2004 to November 2006, a time registration, and a Strengths, Weaknesses, Opportunities, and Threats analysis (SWOT). Although our data are preliminary and the implementation of the team was pragmatic rather than research driven, they provide insight into the development, implementation, functioning and interventions of a Belgian interdisciplinary internal liaison team. PMID:19999385
Braes, Tom; Flamaing, Johan; Pelemans, Walter; Milisen, Koen
school of medicine #12;school of medicine Dr. Richard Hoppmann, Dean "The School of Medicine has, compassionate health care throughout the state and world." #12;the promise of medicine: to students, to society "Wherever the art of medicine is loved, there is also love of humanity." - Hippocrates It is a place where
By the year 2000, over 90% of cases of acquired immunodeficiency syndrome (AIDS) are expected in Third World countries where Western medicine is often unavailable, unaffordable, or culturally unacceptable. Thus, there is a need for greater attention to the potential role of traditional medicine and healers in the prevention and treatment of AIDS. A US-based nongovernmental organization, Green Cross Inc, is examining cross-cultural healing traditions and seeking areas of convergence between scientific bio-medicine and indigenous traditional healing systems. At a street clinic operated by Green Cross in Washington DC, both Western medicine and traditional Chinese practices such as acupuncture, herbal remedies, and meditation are offered to AIDS patients at those at risk of infection. Although the individualized nature of Chinese medicine makes it difficult to evaluate through use of Western research methods, there is anecdotal evidence that it reduces the stress, anxiety, depression, and fatigue that accompany AIDS. Health care systems in all parts of the world could benefit from the concept that illness cannot be treated in isolation from individuals and communities. PMID:12284192
In 1985 and 1986 nuclear medicine became more and more oriented toward in vov chemistry, chiefly as a result of advances in positron emission tomography (PET). The most important trend was the extension of PET technology into the care of patients with brain tumors, epilepsy, and heart disease. A second trend was the increasing use of single-photon emission computed tomography (SPECT).
Wagner, H.N. Jr.
Presents a fascinating look at the practice of medicine aboard commercial and military ships in the 18th and early 19th centuries. Contemporary medical practice believed all diseases were created by one of four "humors." In spite of this, and the constant presence of disease, most seamen led relatively healthy lives. (MJP)
Estes, J. Worth
Nuclear medicine utilizes radioisotopes to diagnose and in some cases treat disease. Modern instruments can image their accumulation in an organ and provide quantitative data when indicated. The strength of these procedures is in the unique physiologic information they provide, rather than the presentation of precise anatomic detail. ImagesFigure 1Figure 2Figure 3 PMID:21267203
Belzberg, Allan S.
Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)
Phillipson, J. David
Contemporary medical education is inadequate to prepare medical students to competently assess and design care plans for patients with acute and chronic pain. The time devoted to pain education in most medical school curricula is brief and not integrated into case-based clinical experiences, and it is frequently nonexistent during clinical clerkships. Medical student pain curricula have been proposed for over 30 years and are commonly agreed upon, though rarely implemented. As a consequence of poor undergraduate pain education, postgraduate trainees and practicing physicians struggle with both competency and practice satisfaction; their patients are similarly dissatisfied. At the University of Washington School of Medicine, a committee of multidisciplinary pain experts has, between 2009 and 2011, successfully introduced a 4-year integrated pain curriculum that increases required pain education teaching time from 6 to 25 hours, and clinical elective pain courses from 177 to 318 hours. It is expected that increased didactic and case-based multidisciplinary clinical training will increase knowledge and competency in biopsychosocial measurement-based pain narrative and risk assessment, improve understanding of persistent pain as a chronic complex condition, and expand the role of patient-centered interprofessional treatment for medical students, residents, and fellows, leading to better prepared practicing physicians. PMID:23523022
Tauben, David J.; Loeser, John D.
These proceedings contain 24 selections, including papers presented at the conference of American Red Cross held in May 1985, on the Subject of transfusion medicine. Some of the titles are: Fluosol/sup R/-DA in Radiation Therapy; Expression of Cloned Human Factor VIII and the Molecular Basis of Gene Defects that Cause Hemophilia; DNA-Probing Assay in the Detection of Hepatitis B Virus Genome in Human Peripheral Blood Cells; and Monoclonal Antibodies: Convergence of Technology and Application.
Murawski, K.; Peetoom, F.
Summary BACKGROUND: In the geriatric population the autopsy rate is low, leading to mortality statistics often based on clinical diagnoses alone. OBJECTIVES: To determine the clinical diagnostic accuracy rate regarding the immediate cause of death (CDARCD), the number of major underlying diseases and sole diagnoses, and general data about the immediate cause of death in geriatric hospitalized patients. METHODS: The autopsy-proven
Johannes Attems; Stephanie Arbes; Gerhard Böhm; Franz Böhmer; Felix Lintner
Master in Molecular Medicine Faculty of Medicine February 2010 #12;University of Ulm There are many of the Master program The English Master course of studies combines the disciplines Biology and Medicine of research, development and application in the field of molecular medicine especially in universities
College of Medicine RM Radiation Medicine KEY: # = new course * = course changed = course dropped and advanced topics in nuclear medicine imaging physics, including positron emission tomographic procedures IN RADIATION MEDICINE. (1-6) Applied field work at the graduate level in the sciences relating to radiation
College of Medicine MED Internal Medicine KEY: # = new course * = course changed = course dropped. (Same as MI/PHA 616.) MED 815 FIRST-YEAR ELECTIVE, MEDICINE. (1-3) With the advice and approval of his of Medicine. The intent is to provide the student an opportunity for exploration and study in an area which
College of Medicine ER Emergency Medicine KEY: # = new course * = course changed = course dropped University of Kentucky 2013-2014 Undergraduate Bulletin 1 ER 815 FIRST-YEAR ELECTIVE, EMERGENCY MEDICINE. (1-year curriculum. Pass-fail only. Prereq: Admission to first year, CollegeofMedicine. ER 825 SECOND-YEAR ELECTIVE
Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological features were extracted; including, sensor placement, derived parameters used to assess fall risk, fall risk classification method, and fall risk classification model outcomes. Results Inertial sensors were placed only on the lower back in the majority of papers (65%). One hundred and thirty distinct variables were assessed, which were categorized as position and angle (7.7%), angular velocity (11.5%), linear acceleration (20%), spatial (3.8%), temporal (23.1%), energy (3.8%), frequency (15.4%), and other (14.6%). Fallers were classified using retrospective fall history (30%), prospective fall occurrence (15%), and clinical assessment (32.5%), with 22.5% using a combination of retrospective fall occurrence and clinical assessments. Half of the studies derived models for fall risk prediction, which reached high levels of accuracy (62-100%), specificity (35-100%), and sensitivity (55-99%). Conclusions Inertial sensors are promising sensors for fall risk assessment. Future studies should identify fallers using prospective techniques and focus on determining the most promising sensor sites, in conjunction with determination of optimally predictive variables. Further research should also attempt to link predictive variables to specific fall risk factors and investigate disease populations that are at high risk of falls. PMID:23927446
Hip fracture represents the most dramatic expression of the disease, in terms of morbidity, medical cost and mortality. The incidence of hip fracture increases substantially with age. The purpose of this study was to evaluate the association between gender and geriatric rehabilitation outcome after traumatic hip fracture. Ninety-nine community-dwelling elderly patients (older than 65 years), 64 women and 35 men, who were admitted to geriatric rehabilitation after operated hip fracture were studied. We assessed the patients' clinical and demographic data, preoperative risk (ASA), type of fracture and orthopedic repair, pain intensity (VAS), cognitive (MMSE), mood (Zung IDS), and functional status (FIM) on admission and at the end of geriatric rehabilitation. Men had higher mean number of comorbid conditions at the time of the fracture. Men recovered more from depressed mood in comparison with women during the rehabilitation. Significant improvement in FIM motor subscore on discharge was found in both groups. The FIM motor subscore gain was higher in men (24.47) in comparison with women (19.22, p=0.036). Those differences were demonstrated in mean subscores of transfers (p=0.004), and locomotion (p=0.019). Women were more functionally dependent in locomotion, transfers and sphincter control. There were no differences between the groups by duration on rehabilitation stay. Recovery after hip fracture depends in large part on the pre-fracture health and functional ability of the patient. Gender differences in functional recovery may affect therapeutic and rehabilitative decision making. Functional recovery after traumatic hip fracture was better in men in comparison with women. PMID:19303648
Arinzon, Zeev; Shabat, Shay; Peisakh, Alexander; Gepstein, Reuven; Berner, Yitshal N
Abstract: Background: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome. Methods: A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP. Results: Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant. Conclusion: Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly. PMID:21502786
Gregersen, Merete; Metz Mørch, Marianne; Hougaard, Kjeld; Marie Damsgaard, Else
The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients. PMID:23498652
González García, Paloma; Manzano Hernández, M Pilar; Muñoz Tomás, M Teresa; Martín Hernández, Carlos; Forcano García, Mercedes
Sports Medicine as an apparent sub-class of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments and postgraduate courses. Although this field of enquiry and practice lays claim to the title 'sports medicine' this paper queries the legitimacy of that claim. Depending upon how 'sports medicine' and 'medicine' are defined, a plausible-sounding case can be made to show that sports medicine is not in fact a branch of medicine. Rather, it is sometimes closer to practices such as non-therapeutic cosmetic surgery. The argument of the paper is as follows. It begins with a brief statement concerning methodology. We then identify and subscribe to a plausible defining goal of medicine taken from a recognised authority in the field. Then two representative, authoritative, definitions of sports medicine are discussed. It is then shown that acceptance of these definitions of sports medicine generates a problem in that if they are accepted, no necessary commitment to the defining goal of medicine is present within sports medicine. It seems to follow that sports medicine is not medicine. In the final part of the paper a critical response to that conclusion is presented and rebutted. The response is one which rejects the identification of the defining goal of medicine upon which our argument rests. PMID:17195578
Edwards, Steven D; McNamee, Mike
Abstract Objective To assess the impact, retention, and magnitude of effect of a required didactic and experiential palliative care curriculum on third-year medical students' knowledge, confidence, and concerns about end-of-life care, over time and in comparison to benchmark data from a national study of internal medicine residents and faculty. Design Prospective study of third-year medical students prior to and immediately after course completion, with a follow-up assessment in the fourth year, and in comparison to benchmark data from a large national study. Setting Internal Medicine Clerkship in a public accredited medical school. Participants Five hundred ninety-three third-year medical students, from July 2002 to December 2007. Main outcome measures Pre- and postinstruction performance on: knowledge, confidence (self-assessed competence), and concerns (attitudes) about end-of-life care measures, validated in a national study of internal medicine residents and faculty. Medical student's reflective written comments were qualitatively assessed. Intervention Required 32-hour didactic and experiential curriculum, including home hospice visits and inpatient hospice care, with content drawn from the AMA-sponsored Education for Physicians on End-of-life Care (EPEC) Project. Results Analysis of 487 paired t tests shows significant improvements, with 23% improvement in knowledge (F1,486=881, p<0.001), 56% improvement in self-reported competence (F1,486=2,804, p<0.001), and 29% decrease in self-reported concern (F1,486=208, p<0.001). Retesting medical students in the fourth year showed a further 5% increase in confidence (p<0.0002), 13% increase in allaying concerns (p<0.0001), but a 6% drop in knowledge. The curriculum's effect size on M3 students' knowledge (0.56) exceeded that of a national cross-sectional study comparing residents at progressive training levels (0.18) Themes identified in students' reflective comments included perceived relevance, humanism, and effectiveness of methods used to teach and assess palliative care education. Conclusions We conclude that required structured didactic and experiential palliative care during the clinical clerkship year of medical student education shows significant and largely sustained effects indicating students are better prepared than a national sample of residents and attending physicians. PMID:22845026
Mullan, Patricia; Nelesen, Richard A.; Soskins, Matt; Savoia, Maria; Buckholz, Gary; Weissman, David E.
that the differential processing of brain StAR protein is regulated by gonadotropins. OVX dramatically suppressed extra-hypo- thalamic brain gonadotropin-releasing hormone 1 receptor expression, and was further suppressed in E2- or PRHR, gonadotropin-releasing hormone 1 receptor; HPG, hypothalamic-pituitary-gonadal; LH, luteinizing hormone; MPA
Wisconsin at Madison, University of
-3043; E-mail: firstname.lastname@example.org standardized neuropsychological tests. This is tied to under- standing of neuropsychological tests to as- sess single domains of cognitive function. Most standardized tests used by clinical structures underlying neuropsychological test performance of elders belonging to three clinical groups
Chapman, Robert M.
Boston University Family Medicine Global Health CollaborativeFamily Medicine As part of the Department of Family Medicine at Boston University, the Collaborative is committed to introducing and improving Family Medicine programs around the world. Family Medicine is a holistic specialty that attends
Spence, Harlan Ernest
Background. Diminished appetite occurs frequently with aging and is considered an important clinical symptom of malnutrition, a condition associated with negative clinical outcome, decreased quality of life, and increased health care costs in hospitalized geriatric patients. Yet, in this population, research is scant on hunger and aversion, the two underlying drives that shape appetite, or on their influence on food intake. This study aimed (a) to examine their interrelationship and respective contribution to food intake; (b) to determine how each relate to other health-related contemporaneous subjective states preceding the meal (good physical health, positive mood, pain); and (c) to explore clinical variables as moderators of the drives–intake relationships to identify population segments for which these relationships are the strongest. Methods. 32 patients (21 women, 11 men; age range, 65–92 years) were observed during repeated meals in a geriatric rehabilitation unit (for a total of 1477 meals). Perceived hunger, aversion, and contemporaneous subjective states were reported before each meal. Protein and energy consumption was calculated from plate leftovers. Clinical measures were obtained from participants ’ medical charts. Results. The hunger–aversion relationship had a low inverse correlation ( p .001), with each uniquely contributing to protein intake (positive and negative effects, respectively; all p,.05). Hunger was positively associated with the perception of physical health and with mood (all p .001). Aversion was associated with pain (p .001). Furthermore, aversion–intake relationships were influenced by moderators, whereas hunger–intake relationships remained constant.
Danielle St-arnaud-mckenzie; Catherine Paquet; Marie-jeanne Kergoat; Guylaine Ferl; Laurette Dubé
Several studies have reported underprescription of anticoagulants in atrial fibrillation (AF). We conducted an observational study on 142 out of a total of 995 consecutive ?75 years old patients presenting AF (14%) when admitted in an emergency unit of a general hospital, in search of geriatric characteristics that might be associated with the underprescription of anticoagulation therapy (mostly antivitamin K at the time of the study). The following data was collected from patients presenting AF: medical history including treatment and comorbidities, CHADS2 score, ISAR scale (frailty), Lawton's scale (ADL), GDS scale (mood status), MUST (nutrition), and blood analysis (INR, kidney function, and albumin). Among those patients for who anticoagulation treatment was recommended (73%), only 61% were treated with it. In the group with anticoagulation therapy, the following characteristics were observed more often than in the group without such therapy: a recent (?6 months) hospitalization and medical treatment including digoxin or based on >3 different drugs. Neither the value of the CHADS2 score, nor the geriatric characteristics could be correlated with the presence or the absence of an anticoagulation therapy. More research is thus required to identify and clarify the relative importance of patient-, physician-, and health care system-related hurdles for the prescription of oral anticoagulation therapy in older patients with AF. PMID:25295192
Objectives To assess a community geriatrics advanced pharmacy practice experience (APPE) that aimed to improve students' attitudes towards older adults and provide a student-directed learning experience. Design Students provided blood pressure monitoring and medication counseling to older adults living in a low-income residential facility as part of a required 6-week ambulatory care service-learning APPE. Pre-experience and post-experience essays on students' perceptions of the elderly and their intended and actual learning were retrospectively reviewed using a qualitative process to determine whether the course objectives were met. Assessment Many students initially described older adults in factual terms or using negative descriptors. Most expressed a desire to increase their knowledge of diseases commonly occurring in and drugs commonly prescribed for the elderly or to improve specific skills. Many students initially had difficulty articulating clear and measurable learning objectives and appropriate assessment metrics, which are important components of self-directed learning. The final essays revealed many students learned more about the humanistic aspects of care than they had anticipated. Conclusion This community-based geriatrics experience improved students' attitudes towards working with older adults and provided practice in developing and assessing their personal learning objectives. PMID:17136175
Sauer, Barbara L.
Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. Methods We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. Results In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). Conclusion Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery. PMID:22949964
Lee, Jung-Hyun; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung
Purpose To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia. Methods A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services. Results Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%), followed by transcription errors (15%), dispensing errors (14%), and prescribing errors (7%). Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant. Conclusion Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors. PMID:24940067
Ernawati, Desak Ketut; Lee, Ya Ping; Hughes, Jeffery David
Background Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy. In this study, we ask whether a mind–body exercise, Tai Chi Chih (TCC), added to escitalopram will augment the treatment of geriatric depression designed to achieve symptomatic remission and improvements in health functioning and cognitive performance. Methods One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks. Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were randomly assigned to 10 weeks of adjunct use of either 1) TCC for 2 hours per week or 2) health education (HE) for 2 hours per week. All participants underwent evaluations of depression, anxiety, resilience, health-related quality of life, cognition, and inflammation at baseline and during 14-week follow-up. Results Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE. Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker, C-reactive protein, compared with the control group. Conclusion Complementary use of a mind–body exercise, such as TCC, may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression. PMID:21358389
Lavretsky, Helen; Altstein, L.; Olmstead, R.E.; Ercoli, L.; Riparetti-Brown, M.; St. Cyr, N.; Irwin, M. R.
An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population. PMID:24131421
Bonwell, Patricia Brown; Parsons, Pamela L; Best, Al M; Hise, Sabrina
Hematopoietic cell transplantation (HCT) provides a life-prolonging or potentially curative treatment option for patients with hematologic malignancies. Given the high transplant-related morbidity, these treatment strategies were initially restricted to younger patients, but are increasingly being used in older adults. The incidence of most hematologic malignancies increases with age; with the aging of the population, the number of potential older candidates for HCT increases. Autologous HCT (auto-HCT) in older patients may confer a slightly increased risk of specific toxicities (such as cardiac toxicities and mucositis) and have modestly lower effectiveness (in the case of lymphoma). However, auto-HCT remains a feasible, safe, and effective therapy for selected older adults with multiple myeloma and lymphoma. Similarly, allogeneic transplant (allo-HCT) is a potential therapeutic option for selected older adults, although fewer data exist on allo-HCT in older patients. Based on currently available data, age alone is not the best predictor of toxicity and outcomes; rather, the comorbidities and functional status of the older patient are likely better predictors of toxicity than chronologic age in both the autologous and allogeneic setting. A comprehensive geriatric assessment (CGA) in older adults being considered for either an auto-HCT or allo-HCT may identify additional problems or geriatric syndromes, which may not be detected during the standard pretransplant evaluation. Further research is needed to establish the utility of CGA in predicting toxicity and to evaluate the quality of survival in older adults undergoing HCT. PMID:24453296
Wildes, Tanya M.; Stirewalt, Derek L.; Medeiros, Bruno; Hurria, Arti
Geriatric patients with dementia and hypertension (DAH) suffer both physically and financially. The needs of these patients mainly include improving the quality of daily living and reducing the cost of long-term care. Traditional treatment approaches are strained to meet these needs. The goal of the paper is to design an innovative system to provide cost-effective quality treatments for geriatric patients with DAH by collecting and analyzing the multi-dimensional personal information, such as observations in daily living (ODL) from a non-clinical environment. The proposed ODLs in paper include activities, cleanliness, blood pressure, medication compliance and mood changes. To complete the system design, an incremental user-centered strategy is exploited to assemble needs of patients, caregivers, and clinicians. A service-oriented architecture (SOA) is employed to make full use of existing devices, software systems, and platforms. This health-related knowledge can be interpreted and utilized to help patients with DAH remain in their homes safely and improve their life quality while reducing medical expenditures.
Xu, Weifeng; Betz, Willian R.; Frezza, Stephen T.; Liu, Yunkai
Background: Old age is associated with weakness of skeletal muscles and decrease in muscle functions. Usually in old-age, people undergo wasting of muscles, so they are more prone for fall and fracture. It has been stated that stress and cognition has an impact on muscle functions. This study was intended to demonstrate the effect of stress in muscle function in geriatrics. Methods: This was a cross sectional study done at a charitable home in Chennai sub urban. The geriatric males and females in the old age home were included in this study. Sixty-four subjects were included and the persons with previous history of musculo skeletal and neurological disorders were excluded. Anthropometric parameters were recorded Maximum Voluntary Contraction (MVC) and Endurance Time (ET) were measured by hand grip dynamometer. Perceived stress score was measured by perceived stress scale questionnaire. Muscle function parameters and stress score was compared. Results: Sixty-four subjects were included in this study and it was found out that there is a negative correlation between MVC & stress which was statistically significant. (r = -0.0675, P = 0.000). Age with MVC & ET showed a mild negative correlation but it was not significant. Conclusion: Hormones released during stress have a negative metabolic effect in skeletal muscle. Stress can induce earlier decline in muscle strength which will eventually lead to fall and fracture. Therefore, stress should be viewed as an independent risk factor for disability and other co morbid conditions. PMID:24596710
Poornima, K.N.; Karthick, N.; Sitalakshmi, R.
The welfare sector in Sweden has undergone extensive changes during the last 15 years, and private and cooperative actors have entered the public market. In the light of high sick-leave rates, especially in female-dominated professions, it is important to identify factors that can help to improve the working conditions and promote health among employees. The purpose of this study was to compare how two of these factors, participation and control, are perceived by employees in three different forms of ownership: public, cooperative and private. In all, 186 employees working at seven geriatric care institutions with three ownership forms were invited to participate in the study. 82% responded to a questionnaire containing issues related to working conditions, e.g. control and participation. The one-way ANOVA and Kruskal-Wallis were used to analyse the findings among the three groups of employees working in public, cooperative or private setting. Results showed that employees in cooperatives experienced more participation than employees working in the public and private sectors in two out of four variables - employee's voice concerning work environment issues and sympathetic response from the manager and decision-making concerning work activities at large. As expected, there were no difference in perceived control between ownership forms, which might be explained by the fact that the work nature in geriatric care is rather regulated, restricted and formalized, regardless of ownership form, resulting in limited freedom over the work situation for the individual employee. PMID:18413929
The present study examines the relationship between systemic hypoperfusion via cardiac output (CO) and neuropsychological performances emphasizing executive function in an aging cohort. Geriatric outpatients with treated, stable cardiovascular disease (CVD) and no history of neurological illness (n=72, ages 56-85) were administered cognitive measures with an emphasis on executive functioning. Echocardiogram findings were used to stratify participants into two groups: low CO (<4.0 L/min) and normal CO (> o r=4.0 L/min). Between-group comparisons were made using ANCOVAs adjusting for systolic blood pressure. The low CO group performed significantly worse than the normal CO group on DKEFS Tower Test and DKEFS Trail Making Test. No significant between-group differences were noted for any of the other cognitive indices. Findings suggest that reduced CO is associated with poorer executive functioning among geriatric outpatients with stable CVD, as the cognitive profile emphasizes a relationship between systemic hypoperfusion and problems with sequencing and planning. The executive dysfunction profile may be secondary to reduced blood flow to vulnerable subcortical structures implicated in frontal-subcortical circuitry. PMID:16469418
Jefferson, Angela L; Poppas, Athena; Paul, Robert H; Cohen, Ronald A
[Purpose] To evaluate the oxidative stress parameters and urinary deoxypyridinoline levels in geriatric patients with osteoporosis. [Subjects and Methods] Eighty geriatric patients aged over 65?years were recruited. Patients were divided into two groups: Group 1 (n=40) consisted of patients with osteoporosis, and Group 2 (n=40) consisted of patients without osteoporosis. Bone mineral density measurements were performed for all patients using DEXA. Oxidative stress parameters were analyzed in blood samples, and deoxypyridinoline levels were analyzed in 24-hour urinary samples. [Results] Compared to Group 2, the total antioxidant status and oxidative stress index levels of Group 1 were not significantly different; however, total oxidant status and 24-hour urinary deoxypyridinoline levels were significantly higher. Pearson correlation coefficients indicated that OSI and urinary deoxypyridinoline levels were not correlated with any biochemical parameters. ROC-curve analysis revealed that urinary deoxypyridinoline levels over 30.80?mg/ml predicted osteoporosis with 67% sensitivity and 68% specificity (area under the curve = 0.734; %95 CI: 0.624–0.844). [Conclusion] Our results indicate that oxidative stress would play a role in the pathogenesis of osteoporosis, and that urinary deoxypyridinoline levels may be a useful screening test for osteoporosis.
Demir, Mehmet; Ulas, Turgay; Tutoglu, Ahmet; Boyaci, Ahmet; Karakas, Emel Yigit; Sezen, Hatice; Ustunel, Murat; Bilinc, Hasan; Gencer, Mehmet; Buyukhatipoglu, Hakan
Anterior screw fixation of Type II odontoid fractures has been recommended. Only few publications analyse the mechanism of failure in geriatric patients. We reviewed 18 male and 15 female patients aged 65 and above for parameters that influence the development of postoperative loss of correction, delayed union or non-union. Patients were stratified in two groups: 21 cases in Group A (union) and 12 patients in Group B (loss of correction, delayed union, non-union, revision surgery). Statistically significant correlation (p < 0.05) could be detected between failure to heal and: (1) degenerative changes in the atlanto-odontoid joint, (2) severity of osteoporosis in the odontoid process, (3) posterior oblique fracture type, (4) suboptimal fracture reduction, (5) suboptimal position of implant following demanding intraoperative conditions, (6) quality of fracture compression and (7) severity of fracture comminution. The overall morbidity and mortality rates were 29.0 and 8.6%, respectively. Our results indicate that these factors should be addressed regarding the selection of the operative treatment method in the geriatric patient. PMID:21728075
Osti, Michael; Philipp, Helmut; Meusburger, Berthold; Benedetto, Karl Peter
Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the recognition of quality in interpretation and knowledge generation within the qualitative research field, I propose a framework by which to evaluate the quality of knowledge generated within generalist, interpretive clinical practice. I describe three priorities for research in developing this model further, which will strengthen and preserve core elements of the discipline of general practice, and thus promote and support the health needs of the public. PMID:21805819
Foreword R. Satava and R. J. Barker; Part I. Introduction to Non-equilibrium Plasma, Cell Biology, and Contamination: 1. Introduction M. Laroussi; 2. Fundamentals of non-equilibrium plasmas M. Kushner and M. Kong; 3. Non-equilibrium plasma sources M. Laroussi and M. Kong; 4. Basic cell biology L. Greene and G. Shama; 5. Contamination G. Shama and B. Ahlfeld; Part II. Plasma Biology and Plasma Medicine: 6. Common healthcare challenges G. Isbary and W. Stolz; 7. Plasma decontamination of surfaces M. Kong and M. Laroussi; 8. Plasma decontamination of gases and liquids A. Fridman; 9. Plasma-cell interaction: prokaryotes M. Laroussi and M. Kong; 10. Plasma-cell interaction: eukaryotes G. Isbary, G. Morfill and W. Stolz; 11. Plasma based wound healing G. Isbary, G. Morfill and W. Stolz; 12. Plasma ablation, surgery, and dental applications K. Stalder, J. Woloszko, S. Kalghatgi, G. McCombs, M. Darby and M. Laroussi; Index.
Laroussi, M.; Kong, M. G.; Morfill, G.; Stolz, W.
Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high. PMID:22770458
Webborn, Nick; Van de Vliet, Peter
From Flying Publisher, _HIV Medicine 2005_ is a free, online "medical textbook that provides a comprehensive and up-to-date overview of the treatment of HIV Infection." This edition is an update of the 2003 version of the textbook (reported on in the June 13, 2003 NSDL Scout Report for Life Sciences). Chapter titles in the textbook include HIV Testing, HIV and Pulmonary Diseases, Mitochondrial Toxicity, HIV and HBV Coinfections, and Traveling with HIV, to name a few. The textbook is available in both German and English. Please note that while certain sections of the 2005 edition are currently available, many sections are still in the process of being published on the site. Sections from the 2003 edition are standing in for some of the forthcoming 2005 sections. The entire 352-page 2003 edition is available for download at this site as well.
Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation Protocol Conditioning: Stationary bike Treadmill #12;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear
Oliver, Douglas L.
The clinical utility of embedded indices of effort in the RBANS was examined in a geriatric sample. Patients were classified as providing suspect effort (n = 45) or probable good effort (n = 258) using the TOMM and clinical consensus. Following the methodology of Silverberg and colleagues (2007), selected individual subtests and a summary Effort Index were evaluated. Setting specificity
Marie D. Barker; Michael David Horner; David L. Bachman
Purpose: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. Design and Methods: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in…
Wong, Eric; Woo, Jean; Hui, Elsie; Ho, Suzanne C.
Strategies for treating cancer are evolving to address the grow- ing number of elderly patients with cancer. Older patients have highly variable physiologic ages, and their treatment should be individualized for optimal outcomes. Treatment paradigms should also take into account the diversity of patients' life expectancy, functional reserve, social sup- port, and personal preference. A Comprehensive Geriatric Assessment (CGA) is
The rationale for this mandatory, guided online e-journal exercise is to foster the ability of students to independently read medical and scientific literature in a critical manner and to integrate journal reading with their basic science knowledge. After a lecture on oxidative phosphorylation, students were assigned to read an article on brown adipose tissue published in New England Journal of Medicine and were guided to analyze the article by answering online questions. After two iterations, student surveys about the project, its key pedagogical features, and ways to improve it suggest that the students perceived these exercises as active learning, which is clinically relevant and built on their course material. Furthermore, students agreed that the e-journal project was useful for learning how to read an article, for reviewing the material learned in class, and for promoting evidence-based medicine. This online e-journal exercise models some aspects students will experience as future physicians, where it is essential to keep up with literature and extract relevant information on a tight physician's schedule. This study demonstrated the usefulness of guided e-journal exercises as a simple effective active teaching tool for preclinical medical students, which can also be used for prehealth undergraduate programs. PMID:24599571
Abali, Emine Ercikan; Phadtare, Sangita; Galt, Jim; Brodsky, Barbara
The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ?67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ? 14). Using a cut-off of ?2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p?0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p?0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration. PMID:24488257
Hamaker, Marije E; Mitrovic, M; Stauder, R
Background Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Methods Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Results Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Conclusions Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs. PMID:24112948
with education-based manuscripts Teaching is supported through continuing grants from the Health Resources Master of Health Policy Master of Public Health Robert Wood Johnson Clinical Scholars Program Basic aging cardiology, muscle and bone disorders). Clinical research programs in aging: bone disorders, cancer, dementia
FAMILY MEDICINE* Definition Of Family medicine is the medical specialty which provides continuing the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity. (1986) (2003) Quality Healthcare In Family Medicine Quality
Finley Jr., Russell L.
All of us will take medicine at some time in our lives. It is important to talk with your doctor about how your medicine could affect your plans to get (or not) get pregnant. Some of the medicine choices you and your doctor make while you are not pregnant can be different from the choices you make when you are pregnant. Although medicines are tested for safety, some medicines may not be safe to take when you are pregnant. If you think you could be pregnant or are not taking steps to avoid pregnancy, do not begin any medicines until you talk with your doctor. Prescription medicines If you are already taking a medicine prescribed by your doctor, and are pregnant or thinking about getting pregnant, talk to your doctor before you stop taking the medicine. ? In some cases, it may be more harmful to stop taking the medicine than to continue taking it ? It may be necessary to reduce the amount of medicine you are taking or change the medicine for something safer in pregnancy Over-The-Counter (OTC) medicines All OTC medicines have a Drug Facts label. The Drug Facts label is arranged the same way on all OTC medicines to make information about using the medicine easier to find. One section of the Drug Facts label is for pregnant women.
... daily routine. For example, take your morning medicine right after you brush your teeth. • Use a chart to check off when you’ve taken your medicines. Telling your health care providers about your medicines Some combinations of medicine and dietary supplements can be harmful. ...
Dance medicine has grown exponentially over the past 10 to 15 years and continues to grow every year as more former professional dancers and stu- dents of dance enter into the field of medicine. Dance medicine is part of the field of performing arts medicine, which specializes in evaluating and treat- ing performing artists such as musicians, dancers, actors\\/actresses, and
Summary Ethical issues in the clinical practice of fetal medicine are discussed, largely from the point of view of early prenatal medicine. The discussion concentrates on several aspects including the time when human life begins, the pros and cons of fetal medicine, and ethical guidelines for fetal medicine. The emphasis is placed on the importance of informed consent and an
Makoto Higurashi; Kumiko Iijima; Hideoki Fukuoka; Yutaka Nakahori
Stroke is an age-related disorder where nearly 70% of the patients are over 70 years of age. More knowledge about the outcome and prognosis among the eldest stroke victims is needed. We studied 171 elderly stroke patients admitted to geriatric wards for rehabilitation. The patients were assessed on admittance to and discharge from hospital, and six and 12 months after the stroke. The mean age was 78.4 years. During the first year, 19% died and 25% were admitted to nursing homes. After 12 months six out of ten patients were living at home. Our results indicate that even elderly stroke patients have a potential for functional improvement after a stroke. PMID:9417692
Thommessen, B; Laake, K; Bautz-Holter, E
Although reserpine and chlorpromazine had tranquilizing effect on a number of geriatric and alcoholic patients in a state hospital, several complicating results were noted, some with a bearing on the patients' health and others that might affect the assignment of personnel. Lipoprotein studies carried out on patients receiving reserpine seemed to indicate that a reduction in the blood levels of the denser lipoprotein molecules took place during therapy. Several elderly patients receiving chlorpromazine died of diseases that were not as sharply manifest by symptoms as they might be expected to be. Hence the need for closer observation than a limited staff could afford seemed a matter for consideration. Another consideration of the same order was the possible need for increased personnel for psychotherapy in light of the more receptive condition of the patients. PMID:13343015
Galioni, E. F.
Assessments of older adults with suspected dementia can be time limited and clinicians might consider using abbreviated versions of measures. The present study examined the concurrent validity of abbreviated WAIS-III index scores in a sample of geriatric patients referred for assessment of suspected dementia (N=43; mean age=63.8 years). All 2-subtest estimates of the Verbal Comprehension, Perceptual Organization, and Working Memory index scores accurately estimated more than 80% of cases within +/-2 standard errors of measurement (S.E.M.), and in most cases, more than 90% of cases were accurate at this level. While none of the 1-subtest estimates of these index scores were as accurate, both of the 1-subtest estimates of the Processing Speed index had high clinical accuracy. Abbreviated versions of the four index scores can be substituted in situations with this clinical population where testing time is limited or a patient fatigues easily. PMID:16524695
Brooks, Brian L; Weaver, Linda E
The ME was described for the first time in 1993. Subsequently other studies with similar designs were performed. The present study, therefore, proposes: (i) to verify the existence of the benefits of exposure to music in elderly subjects with mild cognitive impairment (MCI), (ii) to explore whether it is possible to find any lasting improvement after training, conducted for a long period of time, with such musical pieces, in the measurable cognitive performances. The study we conducted showed that the ME is present in geriatric patients with MCI; the influence on spatial-temporal abilities remains constant in time if the stimulation is maintained. The continuation of our study will consist of increasing the number of individuals examined and in having them listen to music during the study of ECG rhythms and during the acquisition of cerebral functional magnetic resonance imaging (fMRI), and, at the same time, testing them by neuropsychometric methods. PMID:20138674
Cacciafesta, M; Ettorre, E; Amici, A; Cicconetti, P; Martinelli, V; Linguanti, A; Baratta, A; Verrusio, W; Marigliano, V
Objective: This study describes the financial impact of an organized hip fracture program for elderly patients age 65 years and older. Methods: This is a retrospective study of 797 fractures in 776 consecutive patients over a 50-month period (May 2005 to July 2009) treated in an organized hip fracture program for the elderly identified from a quality management database. Financial, demographic, and quality-of-care data were collected. The length of hospital stay, in-hospital complications, and Charlson comorbidity scores were collected from patient records, and all data were evaluated using standard statistical methods. Setting: 261-bed community-based, university-affiliated teaching hospital in an urban setting with a catchment area of approximately 1 million persons. This is a level 3 trauma center. Results: The average total net revenue per hip fracture was $12?159, with an average total cost to hospital of $8264. Physicians' fees consisted of fees collected by surgeons, anesthesiologists, medical specialty consultants, and consulting geriatricians and averaged $2024 per case. Thus, the average hospital charge to payers was $15?188. Compared to Agency for Healthcare Research and Quality average inpatient hospital costs in 2005 of $33?693, a savings of more than $18?000 was realized per patient. The average length of stay was 4.6 days, markedly less than the national average of 6.2 days. Conclusions: This organized geriatric fracture care model with geriatrics comanagement resulted in significant cost savings over a 50-month period, with associated increased quality. With an estimated 330?000 hip fractures annually in the United States, a large cost savings could potentially be realized if this model were more widely applied. PMID:23569657
Kates, Stephen L.; Blake, Deidre; Bingham, Karilee W.; Kates, Olivia S.; Mendelson, Daniel A.; Friedman, Susan M.
The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in the French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports the group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and feed-back on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In this first part of the position paper, its authors analyzed integrated care definitions used in international literature in view of designing the most important components of integrated care. The examination of this concept must be articulated with the idea of "coordination" which has been the cornerstone of the majority of public policies applied to the field of geriatrics and gerontology since the 1960s in France. The components of integrated care highlight that it is an ambitious process leading to real systemic modification. The authors also have proposed to open up a dialogue between citizens' aspirations and integrated care objectives with the aim to verify that the latter respond to the needs as expressed by the targeted group. PMID:24647233
Somme, Dominique; Trouvé, Hélène; Passadori, Yves; Corvez, Alain; Jeandel, Claude; Bloch, Marie-Aline; Ruault, Geneviève; Dupont, Olivier; de Stampa, Matthieu
The final two decades of this century see our planet in a highly perilous condition. This paper, after touching on the problem of nuclear proliferation, goes on to consider three other issues overpopulation, environmental depredation and the future of medical practice all of which are of high salience. The section on population concentrates on the time required for numbers to stabilize at two children per family. Europe is likely to attain stabilization before 2050, North America and the USSR by 2100. In the developing world South and East Asia could also be in balance by the beginning of the twenty-second century; but the situation in Africa vis-à-vis population growth is much more serious and stabilization cannot be anticipated until about 2150. Destruction of life support systems on a massive scale continues, particularly in developing countries. Much of Asia, Africa and Latin America is riddled with soil erosion; expanding populations of humans and livestock are proving a notable catalyst to desertification; the 'firewood crisis' is deepening as slowly but surely the earth is being deforested. There is little convincing evidence that the major aims of the World Conservation Strategy maintenance and responsible utilization of essential ecological systems, preservation of genetic diversity are being obeyed anywhere in the world. In the more sustainable society of the future engineering medicine with its proclivity for resource depletion will be less attractive. Rather will the emphasis be on prevention and on attempting to delineate the environmental factors known to be responsible for an increasing number of diseases. The likely pattern of morbidity and mortality in the twenty-first century is discussed. Geriatric medicine will hold pride of place; the incidence of cancer will rise markedly, and as an increasing number of Third World nations undergo the process of development diseases, which up till now have mainly affected affluent technological societies, it will spread throughout the planet. PMID:6765304
Loraine, J A
Background Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life.\\u000a Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However,\\u000a studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared\\u000a to traditional care. This randomized controlled trial (RCT) aims to investigate whether an
Olav Sletvold; Jorunn L Helbostad; Pernille Thingstad; Kristin Taraldsen; Anders Prestmo; Sarah E Lamb; Arild Aamodt; Roar Johnsen; Jon Magnussen; Ingvild Saltvedt
Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects. PMID:10863351
Myskja, A; Lindbaek, M
136 School of Medicine Medicine Degree options BSc (Single Honours Degree) Medicine Entrance Applied Sciences`Pathway to Medicine'at Perth College The School of Medicine has formed a partnership Andrews. More information can be found on the School of Medicine web pages ( http://medicine
Background. The aim of the present study was to investigate the relationships between personality and quality of life during the course of geriatric rehabilitation, against the background of Cloninger's biosocial theory of personality. Methods. All consecutive patients of a geriatric rehabilitation clinic during one year were evaluated at admission and discharge (N = 687) by means of the ‘‘Vienna List’’ (a newly developed questionnaire for the assessment of quality of life in patients with severe dementia), and two variants of the Temperament and Character Inventory. Results. Self-directedness showed the most general and highest impact on quality of life and successful rehabilitation. Conclusions. It is probable in old and very old individuals who are on their highest level of maturity that the character represents the most important regulatory system in the encounter with challenges of daily life, which necessitates rehabilitation. PMID:19415144
Richter, Jörg; Schwarz, Martina; Bauer, Barbara
This study aimed to investigate the association between vitamin D deficiency and anemia in a hospitalized geriatric population. An observational study, at the acute care geriatric unit of Brest Hospital, France, was conducted among 226 patients aged ?70 years consecutively hospitalized between January 22, 2010 and August 9, 2010. Vitamin D and hemoglobin levels were measured. Vitamin D deficiency was defined as a 25(OH)D level <50 nmol/L and anemia as defined by the World Health Organization. After adjustment for albuminemia, anemia was not significantly associated with vitamin D deficiency (odds ratio (OR)?=?1.37; 95 % confidence interval (CI)?=?0.72-2.6). But anemia was significantly associated with hypoalbuminemia (OR?=?2.08; 95 % CI?=?1.11-3.91). Denutrition reflected by hypoalbuminemia could be a possible confounding factor in the previously described association between anemia and vitamin D deficiency. PMID:23242475
Coutard, A; Garlantézec, R; Estivin, S; Andro, M; Gentric, A
The prevention and treatment of pressure ulcers has always been of paramount concern to geriatric health care providers. The purpose of this study was to examine the relationship between two types of treatments and the degree of wound healing among status post-cerebral vascular accident (CVA) institutionalized geriatric patients with stage II pressure ulcers. Wound dressings were evaluated according to the National Pressure Advisory Panels Pressure Ulcer Scale for Healing (NPUAP, 1997). Fifty long-term care residents were recruited for the study in Queens, New York. A convenience sample was randomly assigned to either of the treatment protocols: polymeric membrane dressing (polymem) or the antibiotic ointment and dry clean dressing (DCD). The findings from the study revealed a significant difference in wound healing scores in the polymeric membrane-dressing group. These findings are limited due to the small sample size and they cannot be generalized to other populations. As this is an initial study, further research is recommended PMID:16294574
Yastrub, Diane J
The debate concerning older people’s life spaces should be based on subjective priorities of the elderly themselves. The purpose\\u000a of this study was therefore to improve the understanding of preferences of elderly care recipients regarding activity-related\\u000a life space (ARLS) and life satisfaction. A mainly qualitative design was used. Fifteen persons aged 80–94 years, undergoing\\u000a geriatric rehabilitation, were interviewed during hospital stay
Anna Cristina Åberg
Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety Inventory (GAI) in a cohort of Australian community-residing older women.Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N = 286).Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety
Gerard J. Byrne; Nancy A. Pachana; Daniela C. Goncalves; Elizabeth Arnold; Robert King; Soo Keat Khoo
Objective The incidence of spinal treatment, including nerve block, radiofrequency neurotomy, instrumented fusions, is increasing, and progressively involves patients of age 65 and older. Treatment of the geriatric patients is often a difficult challenge for the spine surgeon. General health, sociofamilial and mental condition of the patients as well as the treatment techniques and postoperative management are to be accurately evaluated and planned. We tried to compare three treatment methods of spinal stenosis for geriatric patient in single institution. Methods The cases of treatment methods in spinal stenosis over than 65 years old were analyzed. The numbers of patients were 371 underwent nerve block, radiofrequency neurotomy, instrumented fusions from January 2009 to December 2012 (nerve block: 253, radiofrequency neurotomy: 56, instrumented fusions: 62). The authors reviewed medical records, operative findings and postoperative clinical results, retrospectively. Simple X-ray were evaluated and clinical outcome was measured by Odom's criteria at 1 month after procedures. Results We were observed excellent and good results in 162 (64%) patients with nerve block, 40 (71%) patient with radIofrequency neurotomy, 46 (74%) patient with spinal surgery. Poor results were 20 (8%) patients in nerve block, 2 (3%) patients in radiofrequency neurotomy, 3 (5%) patient in spinal surgery. Conclusion We reviewed literatures and analyzed three treatment methods of spinal stenosis for geriatric patients. Although the long term outcome of surgical treatment was most favorable, radiofrequency neurotomy and nerve block can be considered for the secondary management of elderly lumbar spinals stenosis patients.
Park, Chang Kyu; Kim, Min Ki; Park, Bong Jin; Choi, Seok Geun; Lim, Young Jin; Kim, Tae Sung
The aim was to develop and test a questionnaire for use in telephone interviews concerning patient evaluation of geriatric care and rehabilitation. Instrument development was performed comprising qualitative interviews, construction of items, content validation, pilot study and data collection for evaluation of care and rehabilitation, clinical utility, reliability and construct validity. Qualitative interviews were performed with 12 elderly participants. The qualitative interviews formed the basis for the construction of 45 items. An expert panel performed a content validation of the questionnaire resulting in a revised version. A pilot study comprised 29 participants recently discharged from geriatric wards and the main data collection comprised 221 participants. Inclusion criteria were being able to perform a telephone interview and willingness to participate. Clinical utility was examined through questions to the interviewers, answered in writing. Cronbach's alpha coefficient was 0.79. According to a factor analysis and the evaluation of clinical utility, the underlying dimensions of the final revised questionnaire concern 'Respect and safety', 'Information and participation' and 'Rehabilitation interventions', scored in 18 items. In addition, one global item concerns satisfaction with care, resulting in 19 items in total. The revised questionnaire was named PaPeR, Patient Perspective on care and Rehabilitation. The questionnaire is considered valid, reliable and judged to have good clinical utility. The time consumption for the telephone interview is about 10-20 minutes. The questionnaire is useful in defining areas for potential quality improvement in geriatric wards. PMID:16756518
Wressle, Ewa; Eriksson, Lennart; Fahlander, Amie; Rasmusson, Ing-Marie; Tedemalm, Ulla; Tängmark, Karin
Background Data on influenza in the healthcare setting are often based on retrospective investigations of outbreaks and a few studies described influenza during several consecutive seasons. The aim of the present work is to report data on influenza like illness (ILI) and influenza from 5-year prospective surveillance in a short-stay geriatrics unit. Findings A short stay geriatrics unit underwent 5 years of ILI surveillance from November 2004 to March 2009, with the aim of describing ILI in a non-outbreak context. The study was proposed to patients who presented ILI, defined as fever >37.8°C or cough or sore throat. Among 1,353 admitted patients, 115 presented an ILI, and 34 had hospital-acquired ILI (HA-ILI). Influenza was confirmed in 23 patients, 13 of whom had been vaccinated. Overall attack rates were 2.78% and 0.02% for HA-ILI and HA-confirmed influenza respectively, during the 5 seasons. Conclusions This 5-year surveillance study supports the notion that influenza infections are common in hospitals, mostly impacting the elderly hospitalized in short-stay units. It highlights the need for appropriate control measures to prevent HA-ILI in geriatric units and protect elderly patients. PMID:24555834
Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine. PMID:25410068
Zhu, Li; Tian, Chun; Li, Min; Peng, Ming-Qing; Ma, Kun-Long; Wang, Zhong-Lin; Ding, Jia-Hui; Cai, Yi
Combined DMD/MPH Program School of Dental Medicine & School of Medicine Contact Us: For email@example.com 617.636.3646 American Board of Dental Public Health Dental Public Health is one of the nine dental specialty areas recognized by the American Dental Association. Earning a DMD from TUSDM, combined
CollegeofMedicine 130 College of Medicine anatomy and cell Biology Mailing Address: Department of Anatomy and Cell Biology (MC 512) Room 578 CME 808 South Wood Street Chicago, IL 60612-7308 Campus Director of Graduate Studies: Conwell Anderson The Department of Anatomy and Cell Biology offers work
Illinois at Chicago, University of
The Russian Federation's recently adopted family medicine as a specialty, but with little or no training in psychosocial and behavioral issues, unlike many training programs in other countries. The purpose of this qualitative study was to explore the perceptions and experiences of Russian primary care physicians regarding the practice of behavioral medicine and psychosocial methods. Semi-structured in-depth interviews were conducted
David Buyck; Michael Floyd; Fred Tudiver; Lana McGrady; Andrea Journagin; Svetlana Kishenko
Background It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered “minor trauma” with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Methods Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. Results From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP. Conclusion Geriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients. PMID:23519239
Wang, Hao; Coppola, Marco; Robinson, Richard D.; Scribner, James T.; Vithalani, Veer; de Moor, Carrie E.; Gandhi, Raj R.; Burton, Mandy; Delaney, Kathleen A.
The home medicine cabinet contains both drug and non-drug poisons, of varying toxicity. The more seriously toxic ones and old medications, should be removed, since the `steps' of toilet and sink make medicine cabinets accessible even to young children. This article describes the degree of toxicity of items commonly found in medicine cabinets, and recommends storage methods which prevent accidents. Ipecac syrup should be in every medicine cabinet of every home in which there are children.
McGuigan, Michael A.
Medical education is evolving to include more community-based training opportunities. Most frequently, third-and fourth-year medical students have access to these opportunities. However, introducing community-based learning to medical students earlier in their training may provide a more formative experience that guides their perspectives as they enter clinical clerkships. Few known courses of this type exist for first-year medical students. Since 1998, the Morehouse School of Medicine (MSM) has required first-year students to take a yearlong Community Health Course (CHC) that entails conducting a community health needs assessment and developing, implementing, and evaluating a community health promotion intervention. In teams, students conduct health needs assessments in the fall, and in the spring they develop interventions in response to the problems they identified through the needs assessments. At the end of each semester, students present their findings, outcomes, and policy recommendations at a session attended by other students, course faculty, and community stakeholders. The authors describe the course and offer data from the course’s past 11 years. Data include the types of collaborating community sites, the community health issues addressed, and the interventions implemented and evaluated. The MSM CHC has provided students with an opportunity to obtain hands-on experience in collaborating with diverse communities to address community health. Students gain insight into how health promotion interventions and community partnerships can improve health disparities. The MSM CHC is a model that other medical schools across the country can use to train students. PMID:20881688
Buckner, Ayanna V.; Ndjakani, Yassa D.; Banks, Bahati; Blumenthal, Daniel S.
Winter 2007 Practicing Medicine in the Line of Fire #12; UTHealthScienceCenter University of tennessee HealtH science center Medicine Magazine Winter 2007 CommunicationsTeam Writing,Editing ShH science center Medicine Magazine Winner 2006 Gold Award Best Magazine Â External Audience Public Relations
As the knowledge base in sleep disorders medicine has broadened, a subspecialty that we will refer to as “behavioral sleep medicine” area is emerging. This article will define this subspecialty area, provide some historical context for its emergence, review issues related to specialty training and clinical practice, and suggest needs for future research.The term “behavioral sleep medicine” was selected because
Edward J Stepanski; Michael L Perlis
#12;Adam Benoit Medicinal Chemistry Ph.D. Thesis Title: Synthesis and Evaluation of Acridine Country: United States #12;Amit Gangar Medicinal Chemistry Ph.D. Thesis Title: Design and Development Wagner Home Country: India #12;Dan Wang Medicinal Chemistry M.S. Thesis Title: Synthesis and Evaluation
Thomas, David D.
... fluid. Renin inhibitors slow down your body’s production of renin, the enzyme that starts the many chemical reactions that raise your blood pressure. Do these medicines have any side effects? All medicines ... effects of high blood pressure medicines include the following: Chest ...
. Pollett Mount Sinai Hospital University of Toronto Personalized Medicine in GI Oncologic PathologyPathology and Molecular Medicine ANATOMICAL PATHOLOGY GRAND ROUNDS 2012 / 2013 TIME: 12:30 - 1:30 p ROUNDS ARE SPONSORED BY THE DEPARTMENT OF PATHOLOGY AND MOLECULAR MEDICINE Updated: October5, 2012 #12;
Revised 1/2014 Schools of Medicine and Dental Medicine 2014-2015 Student Health Insurance Waiver I at the University of Connecticut School of Medicine, School of Dental Medicine, or School of Public Health. I School of Medicine, School of Dental Medicine, or School of Public Health. I understand I have waived my
Oliver, Douglas L.
Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles. PMID:2222988
Davis, A M; Findley, T W
Food-based nutrition is a main source of physical and spiritual energy and the basis of maintaining healthy growth, development, and regular activity. Because the elderly experience organ degeneration and insufficient energy and nutrition, together with chronic diseases, they need a diet able to deliver proper nutrition and calories. Such diets can help strengthen the physical condition, prevent disease, and even control and treat disease. Therefore, dietary regimens have been viewed as the most basic form of geriatric care, and have also proven highly effective. Traditional