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Sample records for acute geriatric medical

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

    PubMed

    Jackson, M F

    1984-09-01

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

  2. Outcome of patients admitted to an acute geriatric medical unit

    PubMed Central

    Devine, M J; McAleer, J J A; Gallagher, P M; Beirne, J A; McElroy, J G

    1986-01-01

    To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge. PMID:3739060

  3. The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care.

    PubMed

    Goldstein, Judah; McVey, Jennifer; Ackroyd-Stolarz, Stacy

    2016-01-01

    Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step. PMID:26282932

  4. [Geriatric medical education: an unclosed loop].

    PubMed

    Bassan, Norberto D; Soldano, Oraldo R; Vinuesa, Miguel A; Venezia, Sebastian M; Di Sipio, Agustina

    2006-01-01

    Aged population needs competent physicians. This communication studies geriatric medical teaching, intention of first and fourth year students for specializing in Geriatrics and their opinion about its relevance and curricular setting. Curricula from 10 public and 16 private medical schools were analyzed. Students coursing the first (105) and the fourth year (54) completed an ad hoc opinion poll. 98% of the sample never received training in Geriatrics 2% of first year and none of fourth year students revealed intentions in specializing in Geriatrics. 77% of first year and 91% of fourth year students considered Geriatrics as an important specialization whilst 12% and 4% of those students evaluated it as poorly important. 11% and 5% of them did not know what Geriatrics was. 33% of first year and 18% of fourth year students considered Geriatrics as a postgraduate activity whilst 67% and 82%, an undergraduate one (39% and 36% as a particular subject matter and 61% and 64 % included in different ones). The relevance given by medical students to Geriatrics and their interest to be trained on it during their undergraduate stage is shown.

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

    ERIC Educational Resources Information Center

    Shapiro, Johanna; Cho, Beverly

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Polo, Isabel; And Others

    1994-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  9. Guidelines for Graduate Medical Education in Geriatrics.

    ERIC Educational Resources Information Center

    Robbins, Alan S.; Beck, John C.

    1982-01-01

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

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

    PubMed

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

    2005-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    PubMed

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

    2016-04-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  14. A community-based approach for integrating geriatrics and gerontology into undergraduate medical education.

    PubMed

    Martinez, Iveris L; Mora, Jorge Camilo

    2012-01-01

    Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences. This approach is intended to expose students to older adults from diverse communities and adequately prepare students to address the complex and individual needs of these patients. Initial results indicate proficiency in the minimum geriatric competencies covered. The growth and diversity of the older adult population makes it important to integrate and evaluate geriatrics education in undergraduate medical education.

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

    ERIC Educational Resources Information Center

    Martinez, Iveris L.; Mora, Jorge Camilo

    2012-01-01

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

  16. Prolonged stays in hospital acute geriatric care units: identification and analysis of causes.

    PubMed

    Parent, Vivien; Ludwig-Béal, Stéphanie; Sordet-Guépet, Hélène; Popitéan, Laura; Camus, Agnès; Da Silva, Sofia; Lubrano, Anne; Laissus, Frederick; Vaillard, Laurence; Manckoundia, Patrick

    2016-06-01

    In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were women and the SMDHG comprised 315 with a mean age of 86.6 years, of whom 63.2% were women. The two groups were statistically similar for age, sex, living conditions at home (alone or not, help), medical history and number of drugs. Patients in the LMDHG were more dependent (p=0.005), and were more likely to be hospitalized for social reasons (p=0.024) and to have come from their homes (p=0.011) than those in the SMDHG. The reasons for the prolonged stay, more frequent in the LMDHG than the SMDHG (p<0.05), were principally: waiting for imaging examinations, medical complications, and waiting for discharge solutions, assistance from social workers and/or specialist consultations. In order to reduce the MDH in acute geriatric care unit, it is necessary to consider the particularities of the patients who are admitted, their medico-socio-psychological management, access to technical facilities/consultations and post-discharge accommodation. PMID:27277146

  17. How to teach medication management: a review of novel educational materials in geriatrics.

    PubMed

    Ramaswamy, Ravishankar

    2013-09-01

    Medication management is an important component of medical education, particularly in the field of geriatrics. The Association of American Medical Colleges has put forth 26 minimum geriatrics competencies under eight domains for graduating medical students; medication management is one of these domains. The Portal of Geriatric Online education (www.POGOe.org) is an online public repository of geriatrics educational materials and modules developed by geriatrics educators and academicians in the United States, freely available for use by educators and learners in the field. The three POGOe materials presented in this review showcase pearls of medication management for medical and other professional students in novel learning formats that can be administered without major prior preparation. The review compares and contrasts the three materials in descriptive and tabular formats to enable its appropriate use by educators in promoting self-learning or group learning among their learners.

  18. The prevalence of drivers in acute geriatric wards.

    PubMed Central

    Morgan, R.; Turnbull, C. J.; King, D.

    1995-01-01

    An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents. PMID:8545286

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

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Schigelone, Amy Schiller; Ingersoll-Dayton, Berit

    2004-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    PubMed

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

    2014-11-01

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

  3. A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills.

    PubMed

    Supiano, Mark A; Fitzgerald, James T; Hall, Karen E; Halter, Jeffrey B

    2007-10-01

    The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.

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

    PubMed Central

    2014-01-01

    Background Demographic development is accompanied by an increasingly aging society. Concerning medical education, the treatment of older people as well as the scientific research and exploration of ageing aspects in the coming years need to be considered. Aim of the study was to ascertain medical students’ knowledge, interest, and attitudes regarding older patients and geriatric medicine. Methods Each participant completed a self-designed questionnaire. This questionnaire was based on three validated internationally recognised questionnaires (“Facts on Aging Quiz – FAQ”, “Expectations Regarding Aging – ERA” and the “Aging Semantic Differential – ASD”). The inquiry and survey were performed at the beginning of the summer term in 2012 at the University of Regensburg Medical School. Results A total of n = 184/253 (72.7%) students participated in this survey. The results of the FAQ 25+ showed that respondents were able to answer an average of M = 20.4 of 36 questions (56.7%) correctly (Median, Md = 21; SD ±6.1). The personal attitudes and expectations of ageing averaged M = 41.2 points on the Likert-scale that ranged from 0 to 100 (Md = 40.4; SD ±13.7). Respondents’ attitudes towards the elderly (ASD 24) averaged M = 3.5 points on the Likert-scale (range 1–7, Md 3.6, SD ±0.8). Conclusions In our investigation, medical students’ knowledge of ageing was comparable to previous surveys. Attitudes and expectations of ageing were more positive compared to previous studies. Overall, medical students expect markedly high cognitive capacities towards older people that can actively prevent cognitive impairment. However, medical students’ personal interest in medicine of ageing and older people seems to be rather slight. PMID:25062568

  5. Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study

    PubMed Central

    Wetherell, Julie Loebach; Stoddard, Jill A.; White, Kamila S.; Kornblith, Sander; Nguyen, Hoang; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J.

    2014-01-01

    Objective Generalized anxiety disorder (GAD) is a prevalent psychiatric condition in older adults with deleterious effects on health and cognition. Although selective serotonin reuptake inhibitor (SSRI) medications have some efficacy as acute treatments for geriatric GAD, incomplete response is the most common outcome of monotherapy. We therefore developed a novel sequential treatment strategy, using personalized, modular cognitive-behavioral therapy (mCBT) to augment SSRI medication. Method In an open label pilot study (N =10), subjects received a sequenced trial of 12 weeks of escitalopram followed by 16 weeks of escitalopram augmented with mCBT. We also examined the maintenance effects of mCBT over a 28-week follow-up period following drug discontinuation and termination of psychotherapy. Results Results suggest that (1) adding mCBT to escitalopram significantly reduced anxiety symptoms and pathological worry, resulting in full remission for most patients and (2) some patients maintained response after all treatments were withdrawn. Conclusion Findings suggest that mCBT may be an effective augmentation strategy when added to SSRI medication and provide limited support for the long-term benefit of mCBT after discontinuation of pharmacotherapy. PMID:20872925

  6. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  7. Using a Geriatric Mentoring Narrative Program to Improve Medical Student Attitudes towards the Elderly

    ERIC Educational Resources Information Center

    Duke, Pamela; Cohen, Diane; Novack, Dennis

    2009-01-01

    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.…

  8. Medication Errors Among Geriatrics at the Outpatient Pharmacy in a Teaching Hospital in Kelantan

    PubMed Central

    Abdullah, Dellemin Che; Ibrahim, Noor Shufiza; Ibrahim, Mohamed Izham Mohamed

    2004-01-01

    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

  9. Defining the Domain of Geriatric Medicine in an Urban Public Health System Affiliated with an Academic Medical Center

    PubMed Central

    Callahan, Christopher M.; Weiner, Michael; Counsell, Steven R.

    2015-01-01

    The American Geriatrics Society has recommended a reexamination of the roles and deployment of providers with expertise in geriatric medicine. Healthcare systems use a variety of strategies to maximize their geriatric expertise. In general, these health systems tend to focus geriatric medicine resources on a group of older adults that are locally defined as the most in need. This article describes a model of care within an academic urban public health system and describes how local characteristics interact to define the domain of geriatric medicine. This domain is defined using 4 years of data from an electronic medical record combined with data collected from clinical trials. From January 2002 to December 2005, 31,443 adults aged 65 and older were seen at any clinical site within this healthcare system. The mean age was 75 (range 65–105); 61% were women; 35% African American, and 2% Hispanic. The payer mix was 80% Medicare and 17% Medicaid. The local geriatric medicine program includes sites of care in inpatient, ambulatory, nursing home, and home-based settings. By design, this geriatric medicine clinical practice complements the care provided to older adults by the primary care practice. Primary care physicians tend to cede care to geriatric medicine for older adults with advanced disability or geriatric syndromes. This is most apparent for older adults in nursing facilities or those requiring home-based care. There is a dynamic interplay between design features, reputation, and capacity that modulates volume, location, and type of patients seen by geriatrics. PMID:18795983

  10. Geriatric oncology in the Netherlands: a survey of medical oncology specialists and oncology nursing specialists.

    PubMed

    Jonker, J M; Smorenburg, C H; Schiphorst, A H; van Rixtel, B; Portielje, J E A; Hamaker, M E

    2014-11-01

    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.

  11. The severity of initial acute kidney injury at admission of geriatric patients significantly correlates with subsequent in-hospital complications.

    PubMed

    Chao, Chia-Ter; Tsai, Hung-Bin; Wu, Chia-Yi; Lin, Yu-Feng; Hsu, Nin-Chieh; Chen, Jin-Shing; Hung, Kuan-Yu

    2015-09-10

    Acute kidney injury (AKI) is associated with higher hospital mortality. However, the relationship between geriatric AKI and in-hospital complications is unclear. We prospectively enrolled elderly patients (≥65 years) from general medical wards of National Taiwan University Hospital, part of whom presented AKI at admission. We recorded subsequent in-hospital complications, including catastrophic events, incident gastrointestinal bleeding, hospital-associated infections, and new-onset electrolyte imbalances. Regression analyses were utilized to assess the associations between in-hospital complications and the initial AKI severity. A total of 163 elderly were recruited, with 39% presenting AKI (stage 1: 52%, stage 2: 23%, stage 3: 25%). The incidence of any in-hospital complication was significantly higher in the AKI group than in the non-AKI group (91% vs. 68%, p < 0.01). Multiple regression analyses indicated that elderly patients presenting with AKI had significantly higher risk of developing any complication (Odds ratio [OR] = 3.51, p = 0.01) and new-onset electrolyte imbalance (OR = 7.1, p < 0.01), and a trend toward more hospital-associated infections (OR = 1.99, p = 0.08). The risk of developing complications increased with higher AKI stage. In summary, our results indicate that initial AKI at admission in geriatric patients significantly increased the risk of in-hospital complications.

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

    PubMed

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

    2013-11-01

    For more than half a century, scientific research has documented widespread avoidance and even denial of aging. Though nothing new, aversive reactions to the elderly are not only unfortunate but dangerous today, as increasing life expectancy and consequent demand for specialized geriatric medical care vastly outpace the supply of qualified clinicians equipped to provide it. This discrepancy has led to a crisis that is not easily resolved. At the same time, geriatrics reports the highest level of physician satisfaction among medical specialties. How can this apparent disconnect be explained, and what can be done about it? Citing evidence from medicine and other health care disciplines, the authors address these questions by emphasizing the role of aging-related attitudes, a complex but theoretically modifiable construct. Successful educational interventions are described, including the authors' experience at the helm of a monthlong geriatrics clerkship for fourth-year medical students. Novel suggestions are provided to combat the daunting challenges to achieving a workforce that is sufficient both in number and training to effectively meet the needs of the fastest-growing segment of the U.S. population. As patients continue to age across most medical specialties, the importance of geriatric curricula, particularly those sensitizing learners to the need for a systems-based, biopsychosocial (i.e., interdisciplinary) model of care, cannot be overemphasized. Such training, it is argued, should be a standard component of medical education, and future research should focus on identifying specific curricular content and teaching methods that most effectively achieve this end. PMID:24072114

  13. C-reactive protein and the acute phase reaction in geriatric patients.

    PubMed

    Bertsch, Thomas; Triebel, Jakob; Bollheimer, Cornelius; Christ, Michael; Sieber, Cornel; Fassbender, Klaus; Heppner, Hans Jürgen

    2015-10-01

    The C-reactive protein (CRP), first described as a serum component capable of precipitating the C-polysaccharide of pneumococci, is one of the most important proteins because the serum concentration rises in the acute phase reaction. The acute phase reaction is the nonspecific reaction of the body to noxious stimuli of the most varied kinds, such as infections, burns, neoplasms and tissue trauma. The CRP is synthesized in liver parenchymal cells by cytokines which are derived from stimulated leucocytes and released into the circulation. Because of its molecular structure and in synergy with the complement system, it is able to precipitate and/or lyse microorganisms, thereby rendering them harmless. Measurement of the serum CRP concentration can provide important information with respect to the diagnosis and monitoring of treatment. Due to immunosenescence in geriatric patients the synthesis of CRP appears to be limited to inflammatory stimuli; however, this phenomenon does not appear to be of major clinical relevance. Despite the introduction of new parameters of the acute phase reaction, sometimes with better performance, such as interleukin-6, procalcitonin and the soluble endotoxin receptor sCD14, measurement of CRP for diagnosis and treatment monitoring is still justified even in geriatric patients as testing is rapid, economic and nearly ubiquitously available round the clock. Biochemical markers of the acute phase reaction should always be interpreted together with the clinical picture and their specific limitations.

  14. Paul B. Beeson career development awards in aging research and U.S. medical schools aging and geriatric medicine programs.

    PubMed

    Bragg, Elizabeth J; Warshaw, Gregg A; van der Willik, Odette; Meganathan, Karthikeyan; Weber, Debra; Cornwall, Danielle; Leonard, Anthony C

    2011-09-01

    Established in 1995, the Paul B. Beeson Career Development program provides faculty development awards to outstanding junior and midcareer faculty committed to academic careers in aging-related research, training, and practice. This study evaluated the effect of 134 Beeson Scholars on their medical schools' aging and geriatric medicine programs and on the field of aging research from 1995 to 2007. Quantitative and qualitative survey data from multiple sources, including the American Geriatrics Society/Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center, National Institutes of Health (NIH) rankings of research funding, and other governmental databases were used to compare 36 medical schools with Beeson Scholars with 34 similar medical schools without Beeson scholars and to examine the influence of Beeson Scholars on the field of geriatrics and aging. Most Beeson Scholars remained at the institution where they trained during their Beeson award, and 89% are still practicing or conducting research in the field of geriatrics and aging. Twenty-six (19.4%) of the scholars have led institutional research mentoring awards, 51 (39%) report leadership roles in institutional program project grants, and 13 (10%) report leadership roles in the Clinical and Translational Science Award programs at their institutions. Beeson Scholars are more likely than a matched sample of non-Beeson NIH K awardees to study important geriatric syndromes such as falls, cognitive impairment, adverse drug events, osteoporosis, and functional recovery from illness. Total Beeson Impact Years (the total number of years all Beeson Scholars have worked at each school) is positively correlated with more geriatrics research faculty, after controlling for NIH funding rank (P=.02). Beeson Scholars have made positive contributions to the development of academic geriatrics research programs at U.S. medical schools. PMID:21806567

  15. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed.

    PubMed

    Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R

    2016-07-01

    In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation.

  16. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed.

    PubMed

    Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R

    2016-07-01

    In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation. PMID:27305428

  17. Teaching medical student geriatrics competencies in 1 week: an efficient model to teach and document selected competencies using clinical and community resources.

    PubMed

    Atkinson, Hal H; Lambros, Ann; Davis, Brooke R; Lawlor, Janice S; Lovato, James; Sink, Kaycee M; Demons, Jamehl L; Lyles, Mary F; Watkins, Franklin S; Callahan, Kathryn E; Williamson, Jeff D

    2013-07-01

    The Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation published geriatrics competencies for medical students in 2008 defining specific knowledge and skills that medical students should be able to demonstrate before graduation. Medical schools, often with limited geriatrics faculty resources, face challenges in teaching and assessing these competencies. As an initial step to facilitate more-efficient implementation of the competencies, a 1-week geriatrics rotation was developed for the third year using clinical, community, and self-directed learning resources. The Wake Forest University School of Medicine Acute Care for the Elderly Unit serves as home base, and each student selects a half-day outpatient or long-term care experience. Students also perform a home-based falls-risk assessment with a Meals-on-Wheels client. The objectives for the rotation include 20 of the 26 individual AAMC competencies and specific measurable tracking tasks for seven individual competencies. In the evaluation phase, 118 students completed the rotation. Feedback was positive, with an average rating of 7.1 (1 = worst, 10 = best). Students completed a 23-item pre- and post-knowledge test, and average percentage correct improved by 15% (P < .001); this improvement persisted at graduation (2 years after the pretest). On a 12-item survey of attitudes toward older adults, improvement was observed immediately after the rotation that did not persist at graduation. Ninety-seven percent of students documented completion of the competency-based tasks. This article provides details of development, structure, evaluation, and lessons learned that will be useful for other institutions considering a brief, concentrated geriatrics experience in the third year of medical school.

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2010-07-01

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

  20. Medical treatment of acute pancreatitis.

    PubMed

    Mayerle, Julia; Simon, Peter; Lerch, Markus M

    2004-12-01

    Eighty percent of all cases of acute pancreatitis are linked etiologically to gallstone disease or caused by immoderate alcohol consumption. No specific causal treatment for acute pancreatitis exists. Early prognostic factors that indicate severe disease are three or more signs on organ failure scores according to Ranson, Imrie, or Acute Physiology and Chronic Health Evaluation (APACHE) 11, extrapancreatic complications of the disease, or the detection of pancreatic necrosis on CT scans. Elevated CRP levels above 130 mg/L can also predict a severe course of acute pancreatitis. The essential medical treatment for acute pancreatitis is the correction of hypovolemia. Moreover, relief of often severe visceral pain is a high priority. Prophylactic antibiotics should be restricted to patients with necrotizing pancreatitis, infected necrosis, or other infectious complications. Enteral nutrition has no adverse effect compared with parenteral nutrition during the course of acute pancreatitis, and is probably beneficial in regard to outcome.

  1. Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study

    PubMed Central

    Jacobsen, Ellisiv Lærum; Brovold, Therese; Bergland, Astrid; Bye, Asta

    2016-01-01

    Objectives Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. Design A cross-sectional study. Setting Two acute geriatric hospital wards in Norway. Participants This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination <23, language difficulties or severe aphasia. Main outcome measures Nutritional status was assessed using the Mini Nutritional Assessment (MNA). Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. Results On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β −3.3, 95% CI −4.9 to −1.7), pulmonary disease (β −2.1, 95% CI −3.7 to −0.46), cancer (β −1.7, 95% CI −3.4 to −0.033) and nutritional status. Conclusions Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer

  2. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients

    PubMed Central

    Chao, Chia-Ter

    2016-01-01

    Background. Geriatric syndromes (GS) exhibit high prevalence in patients with end-stage renal disease (ESRD) under chronic dialysis irrespective of age. We sought to determine whether GS influences medication adherence in ESRD patients. Methods. A prospective cohort of chronic dialysis patients was assembled. The presence of GS components, including frailty/prefrailty, polypharmacy, and malnutrition, were ascertained through a validated questionnaire, electronic records and chart abstraction, and laboratory tests. The severity of medication non-adherence was defined using the eight-item Morisky Medication Adherence Scale (MMAS). Multiple logistic regression analysis was performed targeting MMAS results and incorporating relevant clinical features and GS. Results. The prevalence of frailty/pre-frailty, polypharmacy, and hypoalbuminemia/ malnutrition among the enrolled participants was 66.7%, 94%, and 14%, respectively. The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6), with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01) were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02) and lower serum albumin, a potential sign of malnutrition (P = 0.03), were associated with poor adherence in another model. Conclusion. This study is among the very few reports addressing GS and medication adherence, especially in ESRD patients. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients. PMID:27326380

  3. [Urosepsis in Geriatric Patients].

    PubMed

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

    2016-02-01

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

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

    PubMed

    2015-11-01

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

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

    PubMed

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

    2010-07-01

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

  6. Multisite geriatrics clerkship for fourth-year medical students: a successful model for teaching the Association of American Medical Colleges' core competencies.

    PubMed

    Oates, Daniel J; Norton, Lisa E; Russell, Matthew L; Chao, Serena H; Hardt, Eric J; Brett, Belle; Kimball, Patricia; Levine, Sharon A

    2009-10-01

    As the population ages, it is important that graduating medical students be properly prepared to treat older adults, regardless of their chosen specialty. To this end, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation convened a consensus conference to establish core competencies in geriatrics for all graduating medical students. An ambulatory geriatric clerkship for fourth-year medical students that successfully teaches 24 of the 26 AAMC core competencies using an interdisciplinary, team-based approach is reported here. Graduating students (N=158) reported that the clerkship was successful at teaching the core competencies, as evidenced by positive responses on the AAMC Graduation Questionnaire (GQ). More than three-quarters (80-93%) of students agreed or strongly agreed that they learned the seven geriatrics concepts asked about on the GQ, which cover 14 of the 26 core competencies. This successful model for a geriatrics clerkship can be used in many institutions to teach the core competencies and in any constellation of geriatric ambulatory care sites that are already available to the faculty.

  7. Impact of a collaborative interprofessional learning experience upon medical and social work students in geriatric health care.

    PubMed

    Gould, Paul Robert; Lee, Youjung; Berkowitz, Shawn; Bronstein, Laura

    2015-01-01

    Interprofessional collaborative practice is increasingly recognized as an essential model in health care. This study lends preliminary support to the notion that medical students (including residents) and social work students develop a broader understanding of one another's roles and contributions to enhancing community-dwelling geriatric patients' health, and develop a more thorough understanding of the inherent complexities and unique aspects of geriatric health care. Wilcoxon Signed Rank Tests of participants' scores on the Index of Interdisciplinary Collaboration (IIC) indicated the training made significant changes to the students' perception of interprofessional collaboration. Qualitative analysis of participants' statements illustrated (1) benefits of the IPE experience, including complementary roles in holistic interventions; and (2) challenges to collaboration. The findings suggest that interprofessional educational experiences have a positive impact upon students' learning and strategies for enhanced care of geriatric patients. PMID:25268507

  8. Electronic Surveillance and Pharmacist Intervention for Vulnerable Geriatric Inpatients on High-Risk Medication Regimens

    PubMed Central

    Peterson, Josh F.; Kripalani, Sunil; Danciu, Ioana; Harrell, Debbie; Marvanova, Marketa; Salanitro, Amanda; Rodriguez, Carmen; Powers, James S.

    2014-01-01

    Background Clinical pharmacists who review medication orders can reduce potentially inappropriate medications (PIMs) in hospitalized elderly patients, but this approach may be inefficient for settings with high clinical volume. Design Pilot intervention. Setting Academic, tertiary care hospital. Participants Hospitalized geriatric patients, age 65 or older, admitted to General Medicine, Orthopedics, and Urology Services during a 3 week period in 2011 and who wereadministered at least one medication from a list of 240 PIMs. Intervention A computerized PIMS dashboard flagged patients with at least one administered PIM or a high calculated anticholinergic score. Additionally, the dashboard displayed 48-hour cumulative narcotic and benzodiazepine administration. Patients were ranked to reflect the estimated risk of an adverse event using logical combinations of data (e.g. use of multiple sedatives in a non-monitored location). In a pilot implementation, a clinical pharmacist reviewed the flagged patient records and delivered an immediate point-of-care intervention for the treating physician. Measurements Clinician response to pharmacist intervention. Results Of797 patients admitted over a three-week period, the PIMS dashboard flagged 179 patients (22%) and 485 patient-medication pairs for review by the clinical pharmacist. Seventy-one patient records with 139patient-medication pairs required additional manual review of the electronic medical record. Twenty-two patients receiving 40 inappropriate medication orders were judged to warrant an intervention, which was delivered by personal communication via phone or text message. Clinicians enacted 31 of 40 (78%) pharmacist recommendations. Conclusion An electronic PIMs dashboard provided an efficient mechanism for clinical pharmacists to rapidly screen the medication regimens of hospitalized elderly and deliver a timely point-of-care intervention when indicated. PMID:25366414

  9. Academic geriatrics in Singapore.

    PubMed

    Wong, Chek Hooi; Landefeld, C Seth

    2011-11-01

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

  10. The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

    PubMed Central

    2013-01-01

    Background The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. Methods In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results The primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of

  11. [Geriatrics - an interdisciplinary challenge].

    PubMed

    Nau, Roland; Djukic, Marija; Wappler, Manfred

    2016-06-01

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

  12. Integrated medical student teaching. A combined course in community medicine, general practice, geriatric medicine and mental health.

    PubMed

    Stout, R W; Irwin, W G

    1982-05-01

    In order to provide "horizontal" integration of related clinical subjects, a combined teaching course in community medicine, general practice, geriatric medicine and mental health has been devised. The course lasts 12 weeks and is divided between joint teaching of topics of common interest and clinical clerkships in individual disciplines. A joint assessment takes place at the end of the course. The course was popular with students who all felt that it covered topics not encountered in other parts of the medical curriculum. A course of this type leads to a better integration of clinical subjects and avoids repetition or omission of topics which are not clearly the responsibility of any individual department.

  13. Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity

    PubMed Central

    Kersten, Hege; Hvidsten, Lara T; Gløersen, Gløer; Wyller, Torgeir Bruun; Wang-Hansen, Marte Sofie

    2015-01-01

    Objective: To identify potentially inappropriate medications (PIMs), to compare drug changes between geriatric and other medical wards, and to investigate the clinical impact of PIMs in acutely hospitalized older adults. Setting and subjects: Retrospective study of 232 home-dwelling, multimorbid older adults (aged ≥75 years) acutely admitted to Vestfold Hospital Trust, Norway. Main outcome measures. PIMs were identified by Norwegian general practice (NORGEP) criteria and Beers’ 2012 criteria. Clinical correlates were laboratory measures, functional and mental status, physical frailty, and length of stay. Results: Mean (SD) age was 86 (5.7) years, and length of stay was 6.5 (4.8) days. During the stay, the mean number of drugs used regularly changed from 7.8 (3.6) to 7.9 (3.6) (p = 0.22), and drugs used pro re nata (prn) changed from 1.4 (1.6) to 2.0 (1.7) (p < 0.001). The prevalence of any PIM changed from 39.2% to 37.9% (p = 0.076), while anticholinergics and benzodiazepines were reduced significantly (p ≤ 0.02). The geriatric ward reduced drug dosages (p < 0.001) and discontinued PIMs (p < 0.001) significantly more often than other medical wards. No relations between number of PIMS and clinical outcomes were identified, but the concomitant use of ≥3 psychotropic/opioid drugs was associated with reduced hand-grip strength (p ≤ 0.012). Conclusion: Hospitalization did not change polypharmacy or PIMs. Drug treatment was more appropriate on the geriatric than other medical wards. No clinical impact of PIMs was observed, but prescribers should be vigilant about concomitant prescription of ≥3 psychotropics/opioids.KEY POINTSAcute hospitalization of older patients with multimorbidity did not increase polypharmacy or potentially inappropriate medications.Prescription of anticholinergics and benzodiazepines was significantly reduced.The geriatric ward reduced drug dosages and discontinued potentially inappropriate medications more

  14. Acute liver failure and self-medication

    PubMed Central

    de OLIVEIRA, André Vitorio Câmara; ROCHA, Frederico Theobaldo Ramos; ABREU, Sílvio Romero de Oliveira

    2014-01-01

    Introduction Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure. Aim To warn about how the practice of self-medication can be responsible for acute liver failure. Method Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute liver failure [tiab] AND acetaminophen [tiab]; self-medication [tiab] AND acetaminophen [tiab]; acute liver failure [tiab] AND dietary supplements [tiab]; self-medication [tiab] AND liver failure [tiab] and self-medication [tiab] AND green tea [tiab]. In Lilacs and SciELO used the descriptor self medication in Portuguese and Spanish. From total surveyed were selected 27 articles and five sites specifically related to the purpose of this review. Conclusions Legislation and supervision disabled and information inaccessible to people, favors the emergence of cases of liver failure drug in many countries. In the list of released drugs that deserve more attention and care, are some herbal medicines used for the purpose of weight loss, and acetaminophen. It is recommended that institutes of health intensify supervision and better orient their populations on drug seemingly harmless, limiting the sale of products or requiring a prescription for release them. PMID:25626943

  15. Geriatric forensics - Part 2 “Prevalence of elder abuse and their potential forensic markers among medical and dental patients”

    PubMed Central

    Mattoo, Khurshid A.; Garg, Rishabh; Kumar, Shalabh

    2015-01-01

    Context: This study is a continuation of the earlier studies and has been extended to investigate the potential forensic markers of elder abuse. Aims: To determine the prevalence of elder abuse in various outpatient departments (OPDs). To study the associated parameters related to the abuser and the abused. To determine the existence of potential forensic markers of elder abuse. Settings and Design: The subjects were randomly selected from the medical and the dental OPDs of the university. Materials and Methods: Eight hundred and thirty two elderly subjects in the age range 40-60 years were interviewed using a questionnaire to determine the existence of elder abuse. The subjects were investigated and examined for weight, nutrition and hydration, vital signs, habits, existing visual and auditory capabilities, medications, disclosure of wills/deeds, signs of depression, and documented cleanliness. The mini-mental state examination, the Geriatric Depression Scale, the Clock drawing test, and the Brief Psychiatric Rating Scale were used to determine the potential forensic markers. Statistical Analysis Used: Mean values in percentage were determined by dividing the number of determined subjects by the total number of subjects for that parameter. Results: About 37% in medical and 41% in dental OPDs were found to have suffered from abuse, mostly in the age group 60-70 years. Females received more abuse and a combination of son and daughter-in-law constituted most abusers. Various potential markers of elder abuse and neglect investigated among the elder abuse victims included depression (89%), signs of improper feeding (83%), changes in personal hygiene (69%), need for medical/dental treatment (78%), medication misuse (67%), changes in wills/deeds (26%), decubiti (10%), bruises (17%), skin tears (27%), and confusion (23%). Conclusions: Elder abuse exists in one or more forms in both medical and dental OPDs among both males and females in all age groups. PMID:26816460

  16. Geriatric Cardiology: An Emerging Discipline.

    PubMed

    Dodson, John A; Matlock, Daniel D; Forman, Daniel E

    2016-09-01

    Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists are encountering patients with a greater number of comorbid illnesses as well as "geriatric conditions," such as cognitive impairment and frailty, which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine to everyday cardiology practice. Accordingly, the tasks of a "geriatric cardiologist" may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review, we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. PMID:27476988

  17. Geriatrics: Profiles in Geriatrics

    MedlinePlus

    ... on the field. more info Todd Semla, Pharm D. Department of Veterans Affairs "I always liked working ... Rice University, a decade earlier. more info Marc D. Rothman, MD Chief Medical Officer, Kindred Healthcare Nursing ...

  18. The economic impact of medical complications in geriatric patients with hip fracture.

    PubMed

    Khasraghi, Fardin A; Lee, Eu Jin; Christmas, Colleen; Wenz, James F

    2003-01-01

    The records of 510 elderly patients with hip fractures admitted to our institution between January 1995 and December 2000 were retrospectively reviewed to determine the incidence and type of developed medical complications and their economic implications. Of those 510 patients, 217 (43%) developed at least 1 medical complication, most frequently electrolyte imbalance (11%), urinary tract infection (10%), respiratory failure (10%), and delirium (9%). Patients who developed medical complications had significantly longer mean hospital stays (10 days) and higher mean hospital costs ($16,203) than patients without such complications (5 days and $10,284, respectively) (P<.001).

  19. Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures in the Geriatric Patient

    PubMed Central

    Stanbury, Spencer Jay; Voloshin, Ilya

    2011-01-01

    Proximal humeral fractures are frequently encountered in the elderly population. While the majority of these fractures can be managed nonoperatively, 2-, 3-, and 4-part fractures, head splitting, and complex fracture dislocations typically require operative management. Open reduction and internal fixation (ORIF) is a popular treatment option for displaced fractures. Advent of locking plates potentially imparts a better option for patients with osteoporotic bone. Hemiarthroplasty has traditionally been used in proximal humeral fractures not amendable to ORIF. While typically providing good pain control, results of hemiarthroplasty have demonstrated inconsistent shoulder motion. Tuberosity malposition or poor healing is a major culprit in unsatisfactory postoperative range of motion. Reverse shoulder arthroplasty has been used in the setting of rotator cuff arthropathy with successful results. Reverse shoulder arthroplasty has recently been used in the setting of acute proximal humeral fractures of the elderly individuals. This technology has shown promising results with mean active anterior elevation from 97° to 122° reported with complication rates of 15% to 28% in short-term studies. Long-term studies and higher level evidence studies with comparison to hemiarthroplasty and ORIF are needed. PMID:23569688

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

    PubMed

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

    2014-05-01

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

  1. Integrating and Evaluating Geriatrics in Medical School: A Novel Approach for the Challenge

    ERIC Educational Resources Information Center

    Besdine, Richard W.; Shield, Renee R.; McNicoll, Lynn; Campbell, Susan E.; Wetle, Terrie

    2011-01-01

    Brown Medical School developed a comprehensive curriculum in which enriched aging content increased from 22 to 80 hours in preclerkship courses and was also added for clerkships, residencies, and nongeriatrician physicians. Innovative evaluation strategies are also described. Highlights include "treasure hunts" in the anatomy laboratory, a…

  2. A Competency-Based Medical Student Curriculum Targeting Key Geriatric Syndromes

    ERIC Educational Resources Information Center

    van Zuilen, Maria H.; Rodriguez, Osvaldo; Mintzer, Michael J.; Paniagua, Miguel A.; Milanez, Marcos N.; Ruiz, Jorge G.; Kaiser, Robert M.; Roos, Bernard A.

    2008-01-01

    The University of Miami Miller School of Medicine (UMMSM) has developed and implemented a competency-based undergraduate medical education (UME) curriculum that targets 61 learning objectives for three geriattic syndromes: dementia, falls, and delirium. This curriculum redesign changed the educational focus from what is taught to what is learned.…

  3. The Importance of "High Valence" Events in a Successful Program for Teaching Geriatrics to Medical Students

    ERIC Educational Resources Information Center

    Boling, Peter A.; Willett, Rita M.; Gentili, Angela; Abbey, Linda J.; Lawson, Sonya R.; Schlesinger, Jeanne B.; Meyers, Elizabeth M.

    2008-01-01

    Virginia Commonwealth University developed an enhanced medical student geriattic curriculum that includes required home visits and nursing home visits for second year students (180 per year), an annual Forum on Aging for all first and second year students, and small group exercises. We added 30 hours of basic science material to pre-clinical…

  4. Medical emergencies: pulmonary embolism and acute severe asthma.

    PubMed

    Somasundaram, K; Ball, J

    2013-01-01

    In this, the second of two articles covering specific medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of pulmonary embolus and acute severe asthma. PMID:23210560

  5. Nutraceuticals for geriatrics

    PubMed Central

    Gupta, Charu; Prakash, Dhan

    2014-01-01

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

  6. Geriatric Technician.

    ERIC Educational Resources Information Center

    Seton Hill Coll., Greensburg, PA.

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

  7. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

    PubMed Central

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  8. Guidelines for parenteral and enteral nutrition support in geriatric patients in China.

    PubMed

    Wei, Junmin; Chen, Wei; Zhu, Mingwei; Cao, Weixin; Wang, Xinying; Shi, Hanping; Dong, Birong; Sun, Jianqin; Chen, Huaihong; Zhou, Yeping; Zhou, Suming; Xu, Jingyong

    2015-01-01

    The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when critically ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, reduced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chinese Medical Association's Group of Geriatric Nutrition Support has developed guidelines by researching the present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).

  9. Reptile geriatrics.

    PubMed

    Paré, Jean A; Lentini, Andrew M

    2010-01-01

    Although basic notions, such as life expectancy, and thus what constitutes old age, remain to be determined in the vast majority of reptile species, there is a tendency at least for captive reptiles to live longer now than in the past. Clinicians are expected to recognize signs of senescence or old age in reptile patients, to acquire a heightened index of suspicion for diseases likely to affect older individuals of a given species or taxon, and to provide sound advice on geriatric care of such patients. Reptiles are stoic and show few signs of aging, but subtle changes in behavior, mobility, reproduction, weight, or appetite may all signal the onset of senescence to the vigilant caregiver. Serial, for example, yearly or biannual physical examination, blood sampling, and imaging initiated at maturity or earlier are probably the most powerful tools in diagnosing, monitoring, and managing geriatric issues.

  10. Geriatrics Educational Outreach: A Tale of Three GRECCs

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  11. Atypical SARS in Geriatric Patient

    PubMed Central

    Oh, Helen M.L.; Hui, K.P.; Lien, Christopher T.C.; Narendran, K.; Heng, B.H.; Ling, A.E.

    2004-01-01

    We describe an atypical presentation of severe acute respiratory syndrome (SARS) in a geriatric patient with multiple coexisting conditions. Interpretation of radiographic changes was confounded by cardiac failure, with resolution of fever causing delayed diagnosis and a cluster of cases. SARS should be considered even if a contact history is unavailable, during an ongoing outbreak. PMID:15030694

  12. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  13. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome.

    PubMed

    Deschler, Barbara; Ihorst, Gabriele; Platzbecker, Uwe; Germing, Ulrich; März, Eva; de Figuerido, Marcelo; Fritzsche, Kurt; Haas, Peter; Salih, Helmut R; Giagounidis, Aristoteles; Selleslag, Dominik; Labar, Boris; de Witte, Theo; Wijermans, Pierre; Lübbert, Michael

    2013-02-01

    Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e.g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/'fatigue' of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and

  14. Virtual patients in geriatric education.

    PubMed

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

    2010-01-01

    The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators have spurred the development of virtual patient programs to teach geriatrics at the medical undergraduate, graduate, and postgraduate levels. As an instructional tool, the Virtual Patient must be placed in the correct educational context to help educators identify opportunities for its proper use in the curriculum. In this review, the experiences of three medical schools in the development and application of geriatric virtual patients are described as case studies. In each case study, the challenges encountered and solutions developed are presented. Areas of future research in the use of virtual patients in geriatrics education include the determination of the optimal combination of features, the settings of use of virtual patient programs, the underlying pedagogy, and the limitations in its application in clinical instruction. PMID:20509062

  15. Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions

    PubMed Central

    Nwani, Paul Osemeke; Nwosu, Maduaburochukwu Cosmas; Nwosu, Monica Nonyelum

    2016-01-01

    Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures accounting for 5.2% (95% CI: 4.17–6.23) of the 1,802 medical admissions during the period under review. There were 49 (52.1%) males and 45 (47.9%) females aged between 18 years and 84 years. The etiological risk factors of acute symptomatic seizures were infections in 36.2% (n = 34) of cases, stroke in 29.8% (n = 28), metabolic in 12.8% (n = 12), toxic in 10.6% (n = 10), and other causes in 10.6% (n = 10). Infective causes were more among those below fifty years while stroke was more in those aged fifty years and above. CNS infections and stroke were the prominent causes of acute symptomatic seizures. This is an evidence of the “double tragedy” facing developing countries, the unresolved threat of infectious diseases on one hand and the increasing impact of noncommunicable diseases on the other one. PMID:26904280

  16. Neuromodulation therapies for geriatric depression.

    PubMed

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

    2015-07-01

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

  17. [Teaching and training in geriatric medicine in the European Union].

    PubMed

    Duursma, S

    2005-04-01

    In 1993 about 20% of the population in the 15 'old' member countries of the European Union (EU) was over 60 years of age and this percentage will increase to more than 25% in 2020. These developments play a key role for the investments in education and training to meet societies needs for health care services. In 2002 about 25% of the medical students in the 'old' EU did not receive any education in geriatric medicine. A question is who will provide the services for older people in related areas, like social care, community care, acute care in the hospitals, long-term care, permanent care and care for psychiatric patients? Geriatric medicine has been recognized as an independent specialty in 8 of the 15 member countries of the 'old' EU. In all EU member states the governments are autonomous regarding all aspects of health care services, including the recognition of specialties and specialist training programmes. A two years training in internal medicine has been recommended in the EU, followed by another four years of training in geriatric medicine. The specialist training has a hospital oriented character, however, it includes also community care and other institutionalised care like nursing homes. The curriculum should contain: biological, social, psychological and medical aspects of common diseases and disturbances in older people. A problem in many EU countries is the shortage of well trained researchers and leading persons for academic positions for geriatric medicine. In a number of countries chairs at the universities remain vacant for long periods of time or even disappear. Good services in the health care for older people need a high quality curriculum and training programme.

  18. Acute Kidney Injury is More Common in Acute Haemorrhagic Stroke in Mymensingh Medical College Hospital.

    PubMed

    Ray, N C; Chowdhury, M A; Sarkar, S R

    2016-01-01

    Acute kidney injury (AKI) is a common complication after acute stroke and is an independent predictor of both early and long-term mortality after acute stroke. Acute kidney injury is associated with increased mortality in haemorrhagic stroke patients. This cross sectional observational study was conducted in Nephrology, Neuromedicine and Medicine department of Mymensingh Medical College & Hospital, Mymensingh from July 2012 to June 2014. A total of 240 patients with newly detected acute stroke confirmed by CT scan of brain were included in this study. According to this study, 15.42% of acute stroke patients developed AKI. Among the patients with haemorrhagic stroke 21.87% developed AKI while only 13.07% patients with ischaemic stroke developed AKI. So, early diagnosis and management of AKI in patients with acute stroke especially in haemorrhagic stroke is very important to reduce the morbidity and mortality of these patients. PMID:26931240

  19. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    PubMed

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation. PMID:26050232

  20. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    PubMed

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.

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

    PubMed Central

    Bardach, Shoshana H.; Rowles, Graham D.

    2012-01-01

    Purpose: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies. Design and Methods: Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center. Findings: Geriatric training varies across health professions’ disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training. Implications: Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula. PMID:22394495

  2. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome

    PubMed Central

    Deschler, Barbara; Ihorst, Gabriele; Platzbecker, Uwe; Germing, Ulrich; März, Eva; de Figuerido, Marcelo; Fritzsche, Kurt; Haas, Peter; Salih, Helmut R.; Giagounidis, Aristoteles; Selleslag, Dominik; Labar, Boris; de Witte, Theo; Wijermans, Pierre; Lübbert, Michael

    2013-01-01

    Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e.g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/’fatigue’ of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and

  3. Profile of Your Geriatric Patient

    PubMed Central

    Longhurst, Mark F.; Slade, Debra

    1990-01-01

    The family doctor cares for many geriatric patients. Many of these patients enter the family practice for the first time, having either recently moved to the area or to a nearby long-term care facility. Obtaining a meaningful patient profile is essential to the physicians' care, allowing future medical decisions to be made in the best interest of that person. Patients' beliefs motivate their functioning in a system. Any system has its own history, structure, and function. PMID:21234029

  4. Medical mitigation strategies for acute radiation exposure during spaceflight.

    PubMed

    Epelman, Slava; Hamilton, Douglas R

    2006-02-01

    The United States Government has recently refocused their space program on manned missions to the Moon by 2018 and later to Mars. While there are many potential risks associated with exploration-class missions, one of the most serious and unpredictable is the effect of acute space radiation exposure, and the space program must make every reasonable effort to mitigate this risk. The two cosmic sources of radiation that could impact a mission outside the Earth's magnetic field are solar particle events (SPE) and galactic cosmic radiation (GCR). Either can cause acute and chronic medical illness. Numerous researchers are currently examining the ability of GCR exposure to induce the development of genetic changes that lead to malignancies and other delayed effects. However, relatively little has been published on the medical management of an acute SPE event and the potential impact on the mission and crew. This review paper will provide the readers with medical management options for an acute radiation event based on recommendations from the Department of Homeland Security (DHS), Centers for Disease Control (CDC), and evidence-based critical analysis of the scientific literature. It is the goal of this paper to stimulate debate regarding the definition of safety parameters for exploration-class missions to determine the level of medical care necessary to provide for the crew that will undertake such missions.

  5. Medical mitigation strategies for acute radiation exposure during spaceflight.

    PubMed

    Epelman, Slava; Hamilton, Douglas R

    2006-02-01

    The United States Government has recently refocused their space program on manned missions to the Moon by 2018 and later to Mars. While there are many potential risks associated with exploration-class missions, one of the most serious and unpredictable is the effect of acute space radiation exposure, and the space program must make every reasonable effort to mitigate this risk. The two cosmic sources of radiation that could impact a mission outside the Earth's magnetic field are solar particle events (SPE) and galactic cosmic radiation (GCR). Either can cause acute and chronic medical illness. Numerous researchers are currently examining the ability of GCR exposure to induce the development of genetic changes that lead to malignancies and other delayed effects. However, relatively little has been published on the medical management of an acute SPE event and the potential impact on the mission and crew. This review paper will provide the readers with medical management options for an acute radiation event based on recommendations from the Department of Homeland Security (DHS), Centers for Disease Control (CDC), and evidence-based critical analysis of the scientific literature. It is the goal of this paper to stimulate debate regarding the definition of safety parameters for exploration-class missions to determine the level of medical care necessary to provide for the crew that will undertake such missions. PMID:16491581

  6. Medical management of the acute radiation syndrome

    PubMed Central

    López, Mario; Martín, Margarita

    2011-01-01

    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2–3 Gy), gastrointestinal (doses 5–12 Gy) and cerebrovascular syndrome (doses 10–20 Gy). There is no possibility to survive after doses >10–12 Gy. The Phases of ARS are—prodromal: 0–2 days from exposure, latent: 2–20 days, and manifest illness: 21–60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 μg/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome. PMID:24376971

  7. Comprehensive Geriatric Assessment in the Office

    PubMed Central

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

    1991-01-01

    Because of their increased incidence of illness and disability, geriatric patients require extra time and diligence to assess and track medical problems. This article describes a comprehensive geriatirc assessment, organized on a one-page, easily updated checklist, that can be used to generate a medical and functional problem list and a risk assessment. Imagesp2190-a PMID:21229091

  8. Improving acute medical management: Junior Doctor Emergency Prescription Cards

    PubMed Central

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC “usability”. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found “easy to use” (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post

  9. Improving acute medical management: Junior Doctor Emergency Prescription Cards.

    PubMed

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97

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

    ERIC Educational Resources Information Center

    Pratt, Clara Collette; And Others

    1982-01-01

    Pharmacists (N=233) responded to the question "What is the most difficult aspect of geriatric pharmacy practice?" Most commonly cited problems were (1) inadequate professional skills or knowledge in geriatrics; (2) patient compliance; (3) physician functioning (including overprescribing of medications); (4) communication with the elderly; (5) lack…

  11. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  12. Medical prevention of recurrent acute otitis media: an updated overview.

    PubMed

    Marchisio, Paola; Nazzari, Erica; Torretta, Sara; Esposito, Susanna; Principi, Nicola

    2014-05-01

    Acute otitis media (AOM) is one of the most common pediatric diseases; almost all children experience at least one episode, and a third have two or more episodes in the first three years of life. The disease burden of AOM has important medical, social and economic effects. AOM requires considerable financial assistance due to needing at least one doctor visit and a prescription for antipyretics and/or antibiotics. AOM is also associated with high indirect costs, which are mostly related to lost days of work for one parent. Moreover, due to its acute symptoms and frequent recurrences, AOM considerably impacts both the child and family's quality of life. AOM prevention, particularly recurrent AOM (rAOM), is a primary goal of pediatric practice. In this paper, we review current evidence regarding the efficacy of medical treatments and vaccines for preventing rAOM and suggest the best approaches for AOM-prone children. PMID:24678887

  13. Medical expenses in treating acute esophageal variceal bleeding

    PubMed Central

    Liu, Chueh-Ling; Wu, Cheng-Kun; Shi, Hon-Yi; Tai, Wei-Chen; Liang, Chih-Ming; Yang, Shih-Cheng; Wu, Keng-Liang; Chiu, Yi-Chun; Chuah, Seng-Kee

    2016-01-01

    Abstract Acute variceal bleeding in patients with cirrhosis is related to high mortality and medical expenses. The purpose of present studies was to analyze the medical expenses in treating acute esophageal variceal bleeding among patients with cirrhosis and potential influencing clinical factors. A total of 151,863 patients with cirrhosis with International Classification of Diseases-9 codes 456.0 and 456.20 were analyzed from the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2010. Time intervals were divided into three phases for analysis as T1 (1996–2000), T2 (2001–2005), and T3 (2006–2010). The endpoints were prevalence, length of hospital stay, medical expenses, and mortality rate. Our results showed that more patients were <65 years (75.6%) and of male sex (78.5%). Patients were mostly from teaching hospitals (90.8%) with high hospital volume (50.9%) and high doctor service load (51.1%). The prevalence of acute esophageal variceal bleeding and mean length of hospital stay decreased over the years (P < 0.001), but the overall medical expenses increased (P < 0.001). Multiple regression analysis showed that older age, female sex, Charlson comorbidity index (CCI) score >1, patients from teaching hospitals, and medium to high or very high patient numbers were independent factors for longer hospital stay and higher medical expenses. Aged patients, female sex, increased CCI score, and low doctor service volume were independent factors for both in-hospital and 5-year mortality. Patients from teaching hospitals and medium to high or very high service volume hospitals were independent factors for in-hospital mortality, but not 5-year mortality. Medical expenses in treating acute esophageal variceal bleeding increased despite the decreased prevalence rate and length of hospital stay in Taiwan. Aged patients, female sex, patients with increased CCI score from teaching hospitals, and medium to high or very high

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

    PubMed Central

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

    2013-01-01

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

  15. Oral flora of elderly patients following acute medical admission.

    PubMed

    Preston, A J; Gosney, M A; Noon, S; Martin, M V

    1999-01-01

    The human oral microflora is diverse and is usually predominately composed of Gram-positive bacteria. It is uncommon to find Gram-negative bacilli (GNB) in healthy mouths. The incidence of infection with GNB rises in institutionalised, frail elderly subjects. There is also evidence of an association between intra-oral GNB presence and denture wearing. There have been few studies which have investigated intra-oral GNB carriage in acutely ill elderly patients. The aim of this study was to evaluate the oral flora of a group of elderly patients during an acute medical admission and to investigate any associations between the oral microflora and existing medical or oral factors. A total of 28 patients (17 females and 11 males; age: 74-93 years) on a care for the elderly ward were studied. Epidemiological data, detailed medical histories and oral examinations were undertaken. In addition, oral swabs of the palate area were taken to determine their oral flora. Twelve (43%) of the patients had GNB in their oral cavities. These patients were suffering from a variety of medical conditions and were on various drug regimes. There was a correlation between oral GNB presence and denture use. There was no association between GNB presence and denture hygiene. As oropharyngeal GNB colonisation can be associated with infections such as aspiration pneumonia, it is important in patients at risk that intra-oral organisms are identified and managed.

  16. [Rehabilitation for musculoskeltal disorders in geriatric patients].

    PubMed

    Shirado, O

    1997-07-01

    Aging is typically accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness in any organs. Musculoskeltal system is one of the most involved organs in geriatric patients. Appropriate roles in geriatric rehabilitation for musculoskeltal disorders should be emphasized not only to treat the disorders, but also to prevent many complications cause by specific disease or injury. Representative management methods in geriatric rehabilitation are introduced in this section. Rest is often effective, especially in the acute phase of illness or injury. However, cautions should be paid in disuse syndrome which may be produced by prolonged bed rest. Major manifestations in this syndrome includes muscle weakness and atrophy, joint contracture, decubitus, osteoporosis, ectopic ossification, cardiovascular impairment, pneumonia, urological and mental problems. Physical agents such as heat, cold, light and pressure have been used as therapeutic agents. Electrical stimulation is often effective in the treatment of low-back pain syndrome. Traction is the act of drawing, or a pulling force. Its mechanism to relieve pain seems to immobilize the injured parts, to increase peripheral circulation by massage effect and to improve muscle spasm. Brace is very effective to control acute pain in musculoskeltal system. However, long-term wear of brace should be avoided to prevent the disuse syndrome. Exercise is one of the most important rehabilitation modalities. This includes stretching and muscle strengthening programs. Education of body mechanism in activity of daily living is essential in rehabilitation of geriatric patients. PMID:9266251

  17. The use of medical orders in acute care oxygen therapy.

    PubMed

    Wong, Ming; Elliott, Malcolm

    The life of every living organism is sustained by the presence of oxygen and the acute deprivation of oxygen will, therefore, result in hypoxia and ultimately death. Although oxygen is normally present in the air, higher concentrations are required to treat many disease processes. Oxygen is therefore considered to be a drug requiring a medical prescription and is subject to any law that covers its use and prescription. Administration is typically authorized by a physician following legal written instructions to a qualified nurse. This standard procedure helps prevent incidence of misuse or oxygen deprivation which could worsen the patients hypoxia and ultimate outcome. Delaying the administration of oxygen until a written medical prescription is obtained could also have the same effect. Clearly, defined protocols should exist to allow for the legal administration of oxygen by nurses without a physicians order because any delay in administering oxygen to patients can very well lead to their death. PMID:19377391

  18. Geriatric medicine in the European Union: future scenarios.

    PubMed

    Duursma, S A; Overstall, P W

    2003-06-01

    The differences in training and services in geriatric medicine between European Union member countries raise some questions: what is a geriatrician, what is geriatric medicine, what will be the future development of the specialty and how does it interact with other medical specialties? To find answers to these questions, a questionnaire was sent to a selected group of 122 geriatricians. The response rate was 60%. A description has been given of what is a geriatrician and what is geriatric medicine. Based on data from the literature and the answers of the respondents six future scenarios were designed. The six scenarios are: the 'healthy old people', the 'adapted specialties', the 'general practitioner + additional training', the 'co-ordinator geriatrician', the 'community geriatrician' and the 'hospital geriatrician'. The answers of the respondents gave doubts whether general practitioners are able to provide the full range of services for geriatric patients in the community. A small majority of the respondents opted for a division of the specialty into community geriatric medicine and hospital geriatric medicine. Such a division offers good opportunities to raise the quality of medical services and to reduce age-related treatment limitation. It is expected that some aspects of geriatric medicine will be included in the training of other specialties and some GPs will obtain additional training. The collected data can not be considered as a representation of the ideas of the European Union geriatricians. However, they may contribute to the discussion on the national and European level about the future of the specialty.

  19. The History of Geriatric Anesthesia in the United States and the Society for the Advancement of Geriatric Anesthesia.

    PubMed

    Rooke, G Alec

    2015-09-01

    Creation of the American Society of Anesthesiologists Committee on Geriatric Anesthesia provided an opportunity for individuals to interact, strategize, and work with medical organizations outside of anesthesiology. These opportunities expanded with creation of the Society for the Advancement of Geriatric Anesthesia. The American Geriatrics Society provided a major boost when they realized it was important for surgical and related specialties to take an active role in the care of older patients. From this have come educational grants to improve residency training and establishment of a major research grant program now managed by the National Institutes of Health. Nevertheless, for improved care of the older patient, the level of involvement has to increase.

  20. Telepsychiatry and geriatric care.

    PubMed

    Jones, B N

    2001-02-01

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

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

    PubMed

    Geduldig, Emma T; Kellner, Charles H

    2016-04-01

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

  2. Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics)

    PubMed Central

    2011-01-01

    Background Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity. Methods/Design Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up. Discussion The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct

  3. [Dizziness in geriatric patients].

    PubMed

    Kirchhoff, Marianne; Andersen, Hanne Elkjær

    2013-11-01

    Dizziness is a common complaint in geriatric patients. Age-related changes in organs of balance control make the elderly more susceptible to diseases affecting the same system causing symptoms as dizziness, balance disturbance, fall and syncope. Work-up should be multifactorial and is feasible in geriatric outpatient clinics. Evidence-based interventions are available. New studies have found high frequency of vestibular dysfunction among old fall patients and suggest an association between vestibular dysfunction and orthostatic hypotension. Further research in this area is needed. PMID:24629235

  4. Impact of Frailty and Other Geriatric Syndromes on Clinical Management and Outcomes in Elderly Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: Rationale and Design of the LONGEVO-SCA Registry.

    PubMed

    Alegre, Oriol; Ariza-Solé, Albert; Vidán, María T; Formiga, Francesc; Martínez-Sellés, Manuel; Bueno, Héctor; Sanchís, Juan; López-Palop, Ramón; Abu-Assi, Emad; Cequier, Àngel

    2016-07-01

    The incidence of acute coronary syndromes (ACS) is high in the elderly. Despite a high prevalence of frailty and other aging-related variables, little information exists about the optimal clinical management in patients with coexisting geriatric syndromes. The aim of the LONGEVO-SCA registry (Impacto de la Fragilidad y Otros Síndromes Geriátricos en el Manejo y Pronóstico Vital del Anciano con Síndrome Coronario Agudo sin Elevación de Segmento ST) is to assess the impact of aging-related variables on clinical management, prognosis, and functional status in elderly patients with ACS. A series of 500 consecutive octogenarian patients with non-ST-segment elevation ACS from 57 centers in Spain will be included. A comprehensive geriatric assessment will be performed during the admission, assessing functional status (Barthel Index, Lawton-Brody Index), frailty (FRAIL scale, Short Physical Performance Battery), comorbidity (Charlson Index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Patients will be managed according to current recommendations. The primary outcome will be the description of mortality and its causes at 6 months. Secondary outcomes will be changes in functional status and quality of life. Results from this study might significantly improve the knowledge about the impact of aging-related variables on management and outcomes of elderly patients with ACS. Clinical management of these patients has become a major health care problem due to the growing incidence of ACS in the elderly and its particularities.

  5. Impact of Frailty and Other Geriatric Syndromes on Clinical Management and Outcomes in Elderly Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: Rationale and Design of the LONGEVO-SCA Registry.

    PubMed

    Alegre, Oriol; Ariza-Solé, Albert; Vidán, María T; Formiga, Francesc; Martínez-Sellés, Manuel; Bueno, Héctor; Sanchís, Juan; López-Palop, Ramón; Abu-Assi, Emad; Cequier, Àngel

    2016-07-01

    The incidence of acute coronary syndromes (ACS) is high in the elderly. Despite a high prevalence of frailty and other aging-related variables, little information exists about the optimal clinical management in patients with coexisting geriatric syndromes. The aim of the LONGEVO-SCA registry (Impacto de la Fragilidad y Otros Síndromes Geriátricos en el Manejo y Pronóstico Vital del Anciano con Síndrome Coronario Agudo sin Elevación de Segmento ST) is to assess the impact of aging-related variables on clinical management, prognosis, and functional status in elderly patients with ACS. A series of 500 consecutive octogenarian patients with non-ST-segment elevation ACS from 57 centers in Spain will be included. A comprehensive geriatric assessment will be performed during the admission, assessing functional status (Barthel Index, Lawton-Brody Index), frailty (FRAIL scale, Short Physical Performance Battery), comorbidity (Charlson Index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Patients will be managed according to current recommendations. The primary outcome will be the description of mortality and its causes at 6 months. Secondary outcomes will be changes in functional status and quality of life. Results from this study might significantly improve the knowledge about the impact of aging-related variables on management and outcomes of elderly patients with ACS. Clinical management of these patients has become a major health care problem due to the growing incidence of ACS in the elderly and its particularities. PMID:27362592

  6. Geriatric Syndromes in Older HIV-Infected Adults

    PubMed Central

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

    2015-01-01

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

  7. Medical Management of Acute Radiation Syndromes : Immunoprophylaxis by Antiradiation Vaccine

    NASA Astrophysics Data System (ADS)

    Popov, Dmitri; Maliev, Vecheslav; Jones, Jeffrey; Casey, Rachael; Kedar, Prasad

    Introduction: Traditionally, the treatment of Acute Radiation Syndrome (ARS) includes supportive therapy, cytokine therapy, blood component transfusions and even stem cell transplantation. Recommendations for ARS treatment are based on clinical symptoms, laboratory results, radiation exposure doses and information received from medical examinations. However, the current medical management of ARS does not include immune prophylaxis based on antiradiation vaccines or immune therapy with hyperimmune antiradiation serum. Immuneprophylaxis of ARS could result from stimulating the immune system via immunization with small doses of radiation toxins (Specific Radiation Determinants-SRD) that possess significant immuno-stimulatory properties. Methods: Principles of immuno-toxicology were used to derive this method of immune prophylaxis. An antiradiation vaccine containing a mixture of Hematotoxic, Neurotoxic and Non-bacterial (GI) radiation toxins, underwent modification into a toxoid forms of the original SRD radiation toxins. The vaccine was administered to animals at different times prior to irradiation. The animals were subjected to lethal doses of radiation that induced different forms of ARS at LD 100/30. Survival rates and clinical symptoms were observed in both control and vaccine-treated animals. Results: Vaccination with non-toxic doses of Radiation toxoids induced immunity from the elaborated Specific Radiation Determinant (SRD) toxins. Neutralization of radiation toxins by specific antiradiation antibodies resulted in significantly improved clinical symptoms in the severe forms of ARS and observed survival rates of 60-80% in animals subjected to lethal doses of radiation expected to induce different forms of ARS at LD 100/30. The most effective vaccination schedule for the antiradiation vaccine consisted of repeated injections 24 and 34 days before irradiation. The vaccine remained effective for the next two years, although the specific immune memory probably

  8. Geriatric Service Worker.

    ERIC Educational Resources Information Center

    Seton Hill Coll., Greensburg, PA.

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

  9. Geriatric Service and Research.

    ERIC Educational Resources Information Center

    Mason, W. Dean, Comp.

    Written by experts in the field of geriatrics, this book is composed of a group of papers. Among the subjects covered in the papers are the news media, the values of the later years, the sciences and aging, and a history of the Home. Several of the articles are written by ministers connected with the religiously oriented facility. Additional…

  10. Geriatric urinary incontinence.

    PubMed

    Ouslander, J G

    1992-02-01

    Urinary incontinence (UI) is now recognized as a prevalent, physically and emotionally disruptive, and costly health problem in the geriatric population. Because incontinence may be a manifestation of a subacute or reversible process within or outside of the lower urinary tract, and because effective treatment is available, it is important for primary care physicians to identify and appropriately assess incontinence in their geriatric patients. The initial evaluation of an incontinent geriatric patients. The initial evaluation of an incontinent geriatric patient includes a targeted history and physical examination, urinalysis, and simple tests of lower urinary tract function. Potentially reversible conditions that may be causing or contributing to the incontinence, such as delirium and urinary tract infection (UTI), should be identified and managed. Patients who may benefit from further testing, including urologic or gynecologic examination and/or complex urodynamic tests, should be identified and referred. Several therapeutic modalities can be used to treat geriatric UI. Behavioral therapies are noninvasive and effective, both in functional community-dwelling geriatric patients and in functionally impaired nursing home residents. Behavioral therapies include bladder training, pelvic muscle exercises, biofeedback, scheduled toileting, habit training, and prompted voiding. Pharmacologic therapy is often used in conjunction with behavioral therapy. For stress incontinence, alpha-adrenergic drugs are used and can be combined with topical or oral estrogen therapy in women. For urge incontinence, pharmacologic treatment involves drugs with anticholinergic and direct bladder muscle relaxant properties. Pharmacologic therapy for overflow incontinence is generally not effective on a long-term basis. Surgical treatment is indicated when a pathologic lesion such as a tumor is diagnosed, or when anatomic obstruction is believed to be the cause of the patient's symptoms

  11. Profile of geriatric pelvic fractures presenting to the emergency department.

    PubMed

    Alost, T; Waldrop, R D

    1997-10-01

    Few studies have examined differences in mechanism, presentation, and outcome of trauma in geriatric patients. This study compared pelvic fractures and associated injuries in geriatric and nongeriatric patients. The medical charts of all patients presenting to a large urban emergency medicine teaching program with a pelvic fracture between January 1, 1987 and December 31, 1993 were retrospectively reviewed by study-blinded physicians. Data collected included mechanism and site of injury, associated injuries, disposition (admission or discharge), need for operative repair, length of hospital stay, as well as subsequent deaths and causes. The data were stratified into patients less than 65 years of age (group A) and 65 years or older (group B). Two-hundred five pelvic fractures were reviewed with 85 (41%) in group B. A significantly greater number of pelvic fractures in group B occurred by fall (86% v 25%, P < .05) and significantly less by motor vehicle accident (14% v 75%, P < .05). Site of pelvic fracture differed significantly only in the decreased number of geriatric iliac fractures (6% v 16%, P < .05). The sites of pelvic fractures for geriatric patients in descending order were multiple sites (58%), pubic rami (56%), acetabulum (19%), ischium (11%), iliac (6%), and sacroiliac (2%), and did not differ from nongeriatric patients. Geriatric patients had significantly fewer total associated injuries (40% v 61%, P < .05) although associated chest injuries were significantly more common (21% v 8%, P < .05). Death occurred in three (3%) nongeriatric and nine (11%) geriatric patients. Six geriatric deaths were caused by exacerbation of underlying cardiovascular disease. Geriatric patients underwent significantly fewer operative procedures (6% v 43%, P < .05) but there were no significant differences in the percent admitted (85%) or mean length of hospital stay (9.59 days). Despite the decreased severity of pelvic fractures, care must be taken to prevent morbidity

  12. Geriatric medicine and cultural gerontology.

    PubMed

    O'Neill, Desmond

    2015-05-01

    T.S. Eliot once proposed that there were two sorts of problems in life. One prompted the question, 'What are we going to do about it?' and the other provoked the questions, 'What does it mean? How does one relate to it?' Geriatric medicine, an eminently practical specialty, has concentrated with good effect on the former but with notable exceptions has yet to devote significant time to the latter. Into this breach has developed an innovative and exciting movement in gerontology to provide a deeper and more comprehensive insight into the meaning of ageing. Largely encompassed by the terms of cultural, humanistic and narrative gerontology, their intent and methodologies in many ways mirror the relationship between the medical humanities, narrative medicine and medicine.

  13. Acute mountain sickness: medical problems associated with acute and subacute exposure to hypobaric hypoxia

    PubMed Central

    Clarke, C

    2006-01-01

    This article summarises the medical problems of travel to altitudes above 3000 m. These are caused by chronic hypoxia. Acute mountain sickness (AMS), a self limiting common illness is almost part of normal acclimatisation—a transient condition lasting for several days. However, in <2% of people staying above 4000 m, serious illnesses related to hypoxia develop – high altitude pulmonary oedema and cerebral oedema. These are potentially fatal but can be largely avoided by gradual ascent. Short vacations, pressure from travel companies and peer groups often encourage ascent to 4000 m more rapidly than is prudent. Sensible guidelines for ascent are outlined, clinical features, management and treatment of these conditions. PMID:17099095

  14. Stroke: advances in medical therapy and acute stroke intervention.

    PubMed

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

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

    PubMed

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

    2002-12-01

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

  16. Geriatric Medicine Is Coming of Age.

    ERIC Educational Resources Information Center

    Steel, Knight

    1984-01-01

    Reviews the present status of geriatrics in academic medicine and suggests that an understanding of academic medicine is needed in order to secure the institutionalization of geriatric medicine. Offers some predictions on the future of geriatric medicine. (JAC)

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

    PubMed

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

    2015-09-01

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

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

    PubMed

    Leistner, K; Bublitz, T

    2004-10-01

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

  19. Origins of British geriatrics.

    PubMed Central

    Howell, T. H.

    1976-01-01

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

  20. Cognitive Deficits in Geriatric Depression: Clinical Correlates and Implications for Current and Future Treatment

    PubMed Central

    Morimoto, Sarah Shizuko; Alexopoulos, George S.

    2013-01-01

    Synopsis The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression, and describe their clinical significance. We then summarize the complex relationship between geriatric depression and dementia and discuss possible shared mechanisms. Last, we present evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation. PMID:24229654

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  2. 75 FR 11638 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-11

    ... palliative care, and performance and oversight of the VA Geriatric Research, Education, and Clinical Centers... Committee assesses the capability of VA health care facilities and programs to meet the medical... and extended care programs, aging research activities, update on VA's geriatric workforce (to...

  3. 78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ... advances in palliative care, and performance and oversight of VA Geriatric Research, Education, and... capability of VA health care facilities and programs to meet the medical, psychological, and social needs of... Centers. The meeting will feature presentations and discussions on VA's geriatrics and extended...

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

    PubMed

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

    2015-02-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed Central

    2015-01-01

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

  7. Do Geriatricians Stay in Geriatrics?

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    PubMed

    Gill, D G; Ingman, S R

    1986-01-01

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

  9. Rapid reengineering of acute medical care for Medicare beneficiaries: the Medicare innovations collaborative.

    PubMed

    Leff, Bruce; Spragens, Lynn H; Morano, Barbara; Powell, Jennifer; Bickert, Terri; Bond, Christy; DeGolia, Peter; Malone, Michael; Glew, Catherine; McCrystle, Sindy; Allen, Kyle; Siu, Albert L

    2012-06-01

    In 2009 we described a geriatric service line or "portfolio" model of acute care-based models to improve care and reduce costs for high-cost Medicare beneficiaries with multiple chronic conditions. In this article we report the early results of the Medicare Innovations Collaborative, a collaborative program of technical assistance and peer-to-peer exchange to promote the simultaneous adoption of multiple complex care models by hospitals and health systems. We found that organizations did in fact adopt and implement multiple complex care models simultaneously; that these care models were appropriately integrated and adapted so as to enhance their adoptability within the hospital or health care system; and that these processes occurred rapidly, in less than one year. Members indicated that the perceived prestige of participation in the collaborative helped create incentives for change among their systems' leaders and was one of the top two reasons for success. The Medicare Innovations Collaborative approach can serve as a model for health service delivery change, ultimately expanding beyond the acute care setting and into the community and often neglected postacute and long-term care arenas to redesign care for high-cost Medicare beneficiaries.

  10. Rapid reengineering of acute medical care for Medicare beneficiaries: the Medicare innovations collaborative.

    PubMed

    Leff, Bruce; Spragens, Lynn H; Morano, Barbara; Powell, Jennifer; Bickert, Terri; Bond, Christy; DeGolia, Peter; Malone, Michael; Glew, Catherine; McCrystle, Sindy; Allen, Kyle; Siu, Albert L

    2012-06-01

    In 2009 we described a geriatric service line or "portfolio" model of acute care-based models to improve care and reduce costs for high-cost Medicare beneficiaries with multiple chronic conditions. In this article we report the early results of the Medicare Innovations Collaborative, a collaborative program of technical assistance and peer-to-peer exchange to promote the simultaneous adoption of multiple complex care models by hospitals and health systems. We found that organizations did in fact adopt and implement multiple complex care models simultaneously; that these care models were appropriately integrated and adapted so as to enhance their adoptability within the hospital or health care system; and that these processes occurred rapidly, in less than one year. Members indicated that the perceived prestige of participation in the collaborative helped create incentives for change among their systems' leaders and was one of the top two reasons for success. The Medicare Innovations Collaborative approach can serve as a model for health service delivery change, ultimately expanding beyond the acute care setting and into the community and often neglected postacute and long-term care arenas to redesign care for high-cost Medicare beneficiaries. PMID:22665832

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

    PubMed Central

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

    2015-01-01

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

  12. Geriatric team dynamics: the dietitian's role.

    PubMed

    Delahanty, L M

    1984-11-01

    In 1980, a geriatric consultation team was formed at Massachusetts General Hospital to meet the complex medical, psychological, rehabilitative, nutritional, and social needs of geriatric patients. This team strives to provide elderly patients with the comprehensive care necessary to potentiate return to maximum independent functioning and to change attitudes of primary caretakers toward care of geriatric patients through increased recognition of the elderly as a heterogeneous group. The team consults on patients with changes in mental status, need for physical rehabilitation, "failure to thrive," or need for definitive planning for posthospital disposition. The dietitian conducts nutritional screening of each patient, is a nutrition resource for team members, and promotes collaboration in nutrition care planning. When the dietitian communicates nutrition concerns, goals, and care plans for patients to other health professionals, they use the information to reinforce her recommendations and integrate nutrition components into their care plans. A multidisciplinary approach has resulted in earlier identification and evaluation of functional ability, more comprehensive individualized care planning, and a reduced percentage of readmissions.

  13. Redefining the Economics of Geriatric Orthopedics

    PubMed Central

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

    2014-01-01

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

  14. The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression.

    PubMed

    Riva-Posse, Patricio; Hermida, Adriana P; McDonald, William M

    2013-12-01

    Geriatric depression is associated with increased mortality because of suicide and decreases in functional and physical health. Many elders' depression is resistant to psychotherapy and medication and can become chronic. Electroconvulsive therapy (ECT) is increasingly used in the treatment of medication-resistant or life-threatening geriatric depression. Neuromodulation therapies (subconvulsive, focal, or subconvulsive and focal) are alternatives for the management of treatment-resistant depression in the elderly. Therapies that combine both strategies could be safer but may not be as effective as ECT. This review covers the evidence on the safety and efficacy of ECT and the neuromodulation therapies in geriatric depression.

  15. Geriatric Training Needs of Nursing-Home Physicians

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  16. Culture Competence in the Training of Geriatric Medicine Fellows

    ERIC Educational Resources Information Center

    Tanabe, Marianne K. G.

    2007-01-01

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

  17. Teaching Programs in Geriatric Optometry.

    ERIC Educational Resources Information Center

    Rosenbloom, Albert A.

    1985-01-01

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

  18. American Association for Geriatric Psychiatry

    MedlinePlus

    ... in your area. Read more » AAGP Journal Official Journal of the American Association for Geriatric Psychiatry. Read more ... RESEARCHERS GMHF Scholars Since my program is so small and there is not much interest among my ...

  19. Trauma in the geriatric population.

    PubMed

    Maxwell, Cathy A

    2015-06-01

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed

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

    2016-04-01

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

  2. Delirium in the elderly: current problems with increasing geriatric age

    PubMed Central

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-01-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multfactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age. PMID:26831414

  3. [Geriatric rehabilitation from the perspective of Book 9 of the German social code, SGB IX].

    PubMed

    Fuchs, H

    2007-10-01

    The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. The article includes a definition of "geriatric rehabilitation" in light of the SGB IX, describes the benefit carriers' obligations as well as the procedure in place for determining geriatric rehab need, in this context appraising the designation as "geriatric patient" in terms of its appropriateness as an identifying criterion in determining need. Provision of geriatric rehab benefits is contingent on a potential for attaining rehab goals as specified by SGB IX as well as on fulfillment of the benefit prerequisites. Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care. PMID:17955397

  4. [Geriatric rehabilitation from the perspective of Book 9 of the German social code, SGB IX].

    PubMed

    Fuchs, H

    2007-10-01

    The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. The article includes a definition of "geriatric rehabilitation" in light of the SGB IX, describes the benefit carriers' obligations as well as the procedure in place for determining geriatric rehab need, in this context appraising the designation as "geriatric patient" in terms of its appropriateness as an identifying criterion in determining need. Provision of geriatric rehab benefits is contingent on a potential for attaining rehab goals as specified by SGB IX as well as on fulfillment of the benefit prerequisites. Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care.

  5. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol.

    PubMed

    Cohen, Alexander Thomas; Spiro, Theodore Erich; Büller, Harry Roger; Haskell, Lloyd; Hu, Dayi; Hull, Russell; Mebazaa, Alexandre; Merli, Geno; Schellong, Sebastian; Spyropoulos, Alex; Tapson, Victor

    2011-05-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately 10 days) subcutaneous (s.c.) enoxaparin for the prevention of VTE in acutely ill medical patients, and whether extended-duration (approximately 5 weeks) rivaroxaban is superior to standard-duration enoxaparin. Patients aged 40 years or older and hospitalized for various acute medical illnesses with risk factors for VTE randomly receive either s.c. enoxaparin 40 mg once daily (od) for 10 ± 4 days or oral rivaroxaban 10 mg od for 35 ± 4 days. The primary efficacy outcomes are the composite of asymptomatic proximal deep vein thrombosis (DVT), symptomatic DVT, symptomatic non-fatal pulmonary embolism (PE), and VTE-related death up to day 10 + 4 and up to day 35 + 4. The primary safety outcome is the composite of treatment-emergent major bleeding and clinically relevant non-major bleeding. As of July 2010, 8,101 patients from 52 countries have been randomized. These patients have a broad range of medical conditions: approximately one-third were diagnosed with acute heart failure, just under one-third were diagnosed with acute infectious disease, and just under one-quarter were diagnosed with acute respiratory insufficiency. MAGELLAN will determine the efficacy, safety, and pharmacological profile of oral rivaroxaban for the prevention of VTE in a diverse population of medically ill patients and the potential of extended-duration therapy to reduce incidence of VTE.

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

    PubMed Central

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

    2014-01-01

    Context: Articles in various international and national bibliographic indices were extensively searched with an emphasis on thyroid and hypothyroid disorders, hypothyroidism in elderly hospitalized patients, hypothyroidism in critically ill geriatric population, thyroxine in elderly hypothyroid, drug interactions and thyroid hormones, and thyroid functions in elderly. Evidence acquisition: Entrez (including PubMed), NIH.gov, Medscape.com, WebMD.com, MedHelp.org, Search Medica, MD consult, yahoo.com, and google.com were searched. Manual search was performed on various textbooks of medicine, critical care, pharmacology, and endocrinology. Results: Thyroid function tests in elderly hospitalized patients must be interpreted with circumspection. The elderly are often exposed to high iodide content and critical care settings. This may occur because of either decreased iodine excretion or very high intake of iodine. This is especially true for elderly population with underlying acute or chronic kidney diseases or both. Amiodarone, with a very high iodine content, is also often used in this set of population. Moreover, other medications including iodinated contrast are often used in the critical care settings. These may affect different steps of thyroid hormone metabolism, and thereby complicate the interpretation of thyroid function tests. Conclusions: The current review is aimed at analyzing and managing various clinical aspects of hypothyroidism in hospitalized elderly, and critically ill geriatric patients. PMID:24719636

  7. Comprehensive Geriatric Care in a Day Hospital: A Demonstration of the British Model in the United States.

    ERIC Educational Resources Information Center

    Morishita, Lynne; And Others

    1989-01-01

    Reviewed 273 medical records and interviewed 42 referring physicians to examine effectiveness of geriatric day hospital (GDH). Found that GDH provided intensive outpatient care, geriatric assessment, rehabilitation, and alternative to hospitalization: 21 percent of physician-referred patients would have been hospitalized without GDH, 7 percent…

  8. Severe Acute Respiratory Syndrome and the Delivery of Continuing Medical Education: Case Study from Toronto

    ERIC Educational Resources Information Center

    Davis, Dave; Ryan, David; Sibbald, Gary; Rachlis, Anita; Davies, Sharon; Manchul, Lee; Parikh, Sagar

    2004-01-01

    Introduction: Severe acute respiratory syndrome (SARS) struck Toronto in the spring of 2003, causing many deaths, serious morbidity, forced quarantine of thousands of individuals, and the closure of all provincial hospitals for several weeks. Given the direction by public health authorities to cancel or postpone all continuing medical education…

  9. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    PubMed

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  10. Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement.

    PubMed

    Levine, Sharon A; Caruso, Lisa B; Vanderschmidt, Hannelore; Silliman, Rebecca A; Barry, Patricia P

    2005-03-01

    As the size of the aged American population increases, so too does the shortage of trained providers in geriatrics. Educational strategies to train physicians at all levels of experience within adult medical and surgical disciplines are needed to complement fellowship training, given the small size of most academic faculties in geriatrics. This article describes a unique faculty development program that creates geriatrically oriented faculty in multiple disciplines. The Boston University Center of Excellence in Geriatrics (COE), funded by the John A. Hartford Foundation, has trained 25 faculty members. Four to six scholars enter the program each year and participate in the COE 1 day per week. Nine months are spent in four content modules-Geriatrics Content, Clinical Teaching, Evidence-based Medicine, and Health Care Systems; 3 months are spent in supervised scholarly activities and clinical settings. A self-report questionnaire and a structured interview were used to evaluate the outcomes of participation in the COE. The results from the first 4 years of the program are reported. The response rate was 83% for the self-report questionnaire and 75% for the structured interview. The results indicate that the COE is effective in improving scholars' assessment and management of older patients. The structured interview revealed that the COE program promotes the integration of geriatrics into clinical teaching at the medical student and resident level. Participants also completed scholarly projects in geriatrics. This program effectively trains faculty scholars to better care for older adults and to teach others to do likewise.

  11. Geriatric Trauma: A Radiologist's Guide to Imaging Trauma Patients Aged 65 Years and Older.

    PubMed

    Sadro, Claudia T; Sandstrom, Claire K; Verma, Nupur; Gunn, Martin L

    2015-01-01

    Radiologists play an important role in evaluation of geriatric trauma patients. Geriatric patients have injury patterns that differ markedly from those seen in younger adults and are susceptible to serious injury from minor trauma. The spectrum of trauma in geriatric patients includes head and spine injury, chest and rib trauma, blunt abdominal injury, pelvic fractures, and extremity fractures. Clinical evaluation of geriatric trauma patients is difficult because of overall frailty, comorbid illness, and medication effects. Specific attention should be focused on the effects of medications in this population, including anticoagulants, steroids, and bisphosphonates. Radiologists should use age-appropriate algorithms for radiography, computed tomography (CT), and magnetic resonance imaging of geriatric trauma patients and follow guidelines for intravenous contrast agent administration in elderly patients with impaired renal function. Because there is less concern about risk for cancer with use of ionizing radiation in this age group, CT is the primary imaging modality used in the setting of geriatric trauma. Clinical examples are provided from the authors' experience at a trauma center where geriatric patients who have sustained major and minor injuries are treated daily. PMID:26065932

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

    PubMed

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

    2006-02-01

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

  13. Novel ethical dilemmas arising in geriatric clinical practice.

    PubMed

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

    2015-05-01

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

  14. The development of an outcomes management system for acute medical rehabilitation.

    PubMed

    Cohen, B A; Grigonis, A M; Topper, M E; Morrison, M H

    1997-01-01

    In 1993, Continental Medical Systems, Inc. (CMS), a provider of comprehensive medical rehabilitation, developed the Total Outcomes and Prediction Program (TOPP) to measure and evaluate key medical rehabilitation outcomes, quality indicators, and patient satisfaction at its 37 acute rehabilitation hospitals. The broad purposes of TOPP are to manage patient treatment, improve the cost-effectiveness of care, and provide outcomes reporting for managed care and other interested parties. The challenge was to develop a system which could measure, evaluate, and report medical rehabilitation patient outcomes in a way that could be easily understood by multiple audiences, including payers, accrediting organizations, physicians, patients and families, case managers, and CMS clinical staff. Using data from the Uniform Data System for Medical Rehabilitation database, CMS created descriptive outcomes reports for each hospital and for the corporation overall, including performance statistics, outcomes report cards, and quality report cards. These initial reports, as well as updates, quarterly reports, and special ad hoc requests, provide CMS corporate and hospital staff with statistically valid and reliable information to manage the outcomes of medical rehabilitation treatment. TOPP has assisted CMS with meeting accreditation standards for outcomes management and measurement and has been used in managed care contract negotiations. Future TOPP efforts will integrate resource use data, medical acuity and outcomes from acute, subacute, and outpatient rehabilitation levels into CMS' outcomes reporting system. PMID:9116528

  15. Client services for geriatric pets.

    PubMed

    Hancock, G; Yates, J

    1989-01-01

    Some veterinarians have been reluctant to discuss the prospect of the death of a pet because of a sense of discomfort and a lack of understanding about how to respond to the client's grief reaction. It is essential to take the time for this important communication and help clients deal with fears about the process, any feelings of guilt and helplessness, and judgments about the medical aspects of a case. Clients must be encouraged to express grief over the loss of a pet, particularly a geriatric pet that has lived with them many years and to which they are deeply bonded. Veterinarians need to counsel clients about obtaining additional pets or another pet. The phrase "replacement pet" must be stricken from the veterinarian's vocabulary. One does not "replace" a deceased spouse, mother, father, or child. It is possible to have another child or find another spouse, but it is not possible to replace a person. Neither can a pet be "replaced," because each pet is a unique living being. It is disrespectful to the memory of deceased pets to belittle their uniqueness by suggesting that they can be replaced. Instead, the veterinarian has the capability and responsibility to help pet owners maintain fond and happy memories of an irreplacable pet, while finding room in their hearts for another new pet to create happiness for the future. Once the grief is resolved, clients will be thankful for having had the privilege of sharing their life with an animal and experiencing the joy of the bond between two unique individuals. PMID:2646816

  16. Client services for geriatric pets.

    PubMed

    Hancock, G; Yates, J

    1989-01-01

    Some veterinarians have been reluctant to discuss the prospect of the death of a pet because of a sense of discomfort and a lack of understanding about how to respond to the client's grief reaction. It is essential to take the time for this important communication and help clients deal with fears about the process, any feelings of guilt and helplessness, and judgments about the medical aspects of a case. Clients must be encouraged to express grief over the loss of a pet, particularly a geriatric pet that has lived with them many years and to which they are deeply bonded. Veterinarians need to counsel clients about obtaining additional pets or another pet. The phrase "replacement pet" must be stricken from the veterinarian's vocabulary. One does not "replace" a deceased spouse, mother, father, or child. It is possible to have another child or find another spouse, but it is not possible to replace a person. Neither can a pet be "replaced," because each pet is a unique living being. It is disrespectful to the memory of deceased pets to belittle their uniqueness by suggesting that they can be replaced. Instead, the veterinarian has the capability and responsibility to help pet owners maintain fond and happy memories of an irreplacable pet, while finding room in their hearts for another new pet to create happiness for the future. Once the grief is resolved, clients will be thankful for having had the privilege of sharing their life with an animal and experiencing the joy of the bond between two unique individuals.

  17. Anesthesia and analgesia for geriatric veterinary patients.

    PubMed

    Baetge, Courtney L; Matthews, Nora S

    2012-07-01

    The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

  18. Geriatric syndromes--vascular disorders?

    PubMed

    Strandberg, Timo E; Pitkälä, Kaisu H; Tilvis, Reijo S; O'Neill, Desmond; Erkinjuntti, Timo J

    2013-05-01

    The term geriatric syndrome is used to characterize multifactorial clinical conditions among older people which are not subsumed readily into disease entities, but which nevertheless predispose older people to disability and death. Commonly included are frailty, dementia, delirium, incontinence, falls, and dizziness. Geriatric syndromes are common among older people: in a recent survey, 50% of those aged more than 65 had one or more of these conditions. Better methods for prevention and treatment are needed, but current strategies have lacked a coherent conceptual and diagnostic framework. Prevention and interventions need to be targeted at earlier ages, with geriatrics expertise needed in the definition and operationalization of these complex entities. In this review we consolidate evidence that vascular disorders, including vascular ageing and vascular diseases, are key etiological factors of geriatric syndromes. Identifying this vascular dimension would offer opportunities for more efficient preventive strategies and mandates earlier intervention, especially for women, among whom vascular disease is often expressed more insidiously than among men. This would entail a sensitization of the health care system to the systematic detection of the syndromes, which are currently underdiagnosed. Further disentangling of the mechanisms of vascular ageing may offer therapies for vascular diseases and geriatric syndromes alike.

  19. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new?

    PubMed Central

    Andrew, Rachel E; Messaris, Evangelos

    2016-01-01

    Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC. PMID:27721922

  20. Neuroplasticity-Based Computerized Cognitive Remediation for Geriatric Depression

    PubMed Central

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

    2012-01-01

    Objective This article describes a novel treatment model designed to target specific neurocognitive deficits in geriatric depression with neuroplasticity-based computerized cognitive remediation (NBCCR). Method The recent National Institute of Mental Health (NIMH) report “From Discovery to Cure” calls for studies focusing on mechanisms of treatment response with the goal of arriving at new interventions for those who do not respond to existing treatments. We describe the process that led to the identification of specific executive deficits and their underlying neurobiology, as well as the rationale for targeting these symptoms as a part of a strategy intended to improve both executive dysfunction and depression. We then propose a strategy for further research in this emerging area Results and Conclusions Despite significant developments, conventional antidepressant treatments leave many older adults still depressed and suffering (Thase, Entsuah et al. 2001). Psychotherapy may be effective in some depressed elders, although a recent review concluded that none of the available treatment studies meets stringent criteria for efficacy in the acute treatment of geriatric depression(Kiosses, Leon et al.). Appropriately developed and targeted NBCCR, has the potential to serve as a novel treatment intervention for geriatric depression. Pathophysiological changes associated with executive dysfunction may be an appropriate target for NBCCR. Examining both behavioral changes and indices of structural integrity and functional change of networks related to cognitive and emotional regulation may lead to a novel treatment and elucidate the role of specific cerebral networks in geriatric depression. PMID:22451346

  1. Electronic Medical Record-Based Predictive Model for Acute Kidney Injury in an Acute Care Hospital.

    PubMed

    Laszczyńska, Olga; Severo, Milton; Azevedo, Ana

    2016-01-01

    Patients with acute kidney injury (AKI) are at risk for increased morbidity and mortality. Lack of specific treatment has meant that efforts have focused on early diagnosis and timely treatment. Advanced algorithms for clinical assistance including AKI prediction models have potential to provide accurate risk estimates. In this project, we aim to provide a clinical decision supporting system (CDSS) based on a self-learning predictive model for AKI in patients of an acute care hospital. Data of all in-patient episodes in adults admitted will be analysed using "data mining" techniques to build a prediction model. The subsequent machine-learning process including two algorithms for data stream and concept drift will refine the predictive ability of the model. Simulation studies on the model will be used to quantify the expected impact of several scenarios of change in factors that influence AKI incidence. The proposed dynamic CDSS will apply to future in-hospital AKI surveillance in clinical practice. PMID:27577501

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

    PubMed

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

    2016-11-01

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

  3. Geriatric Dentistry in the Predoctoral Curriculum.

    ERIC Educational Resources Information Center

    Moshman, Jack; And Others

    1985-01-01

    A survey of U.S. dental schools to determine the status of geriatric dentistry in the curriculum is discussed. Evidence of growing commitment is shown by deans who plan to give geriatric dentistry increasing priority in the future and by the fact that all schools now teach geriatric dentistry in some way. (MLW)

  4. Loss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?

    PubMed

    Schütz, Philipp; Bally, Martina; Stanga, Zeno; Keller, Ulrich

    2014-01-01

    Loss of appetite and ensuing weight loss is a key feature of severe illnesses. Protein-energy malnutrition (PEM) contributes significantly to the adverse outcome of these conditions. Pharmacological interventions to target appetite stimulation have little efficacy but considerable side effects. Therefore nutritional therapy appears to be the logical step to combat inadequate nutrition. However, clinical trial data demonstrating benefits are sparse and there is no current established standard algorithm for use of nutritional support in malnourished, acutely ill medical inpatients. Recent high-quality evidence from critical care demonstrating harmful effects when parenteral nutritional support is used indiscriminately has led to speculation that loss of appetite in the acute phase of illness is indeed an adaptive, protective response that improves cell recycling (autophagy) and detoxification. Outside critical care, there is an important gap in high quality clinical trial data shedding further light on these important issues. The selection, timing, and doses of nutrition should be evaluated as carefully as with any other therapeutic intervention, with the aim of maximising efficacy and minimising adverse effects and costs. In light of the current controversy, a reappraisal of how nutritional support should be used in acutely ill medical inpatients outside critical care is urgently required. The aim of this review is to discuss current pathophysiological concepts of PEM and to review the current evidence for the efficacy of nutritional support regarding patient outcomes when used in an acutely ill medical patient population outside critical care. PMID:24782139

  5. "Eat your lunch!" - controversies in the nutrition of the acutely, non-critically ill medical inpatient.

    PubMed

    Schuetz, Philipp

    2015-01-01

    There is no doubt about the strong association of malnutrition and adverse medical outcomes including mortality, morbidity and quality of life. Particularly in the elderly and frail medical inpatient population, loss of appetite due to the acute illness further aggravates nutritional status. In fact, this relationship between acute disease and eating behaviour / nutritional status may well be bidirectional, with not only illness affecting nutritional status, but also dietary factors influencing the course of illness. Whether loss of appetite associated with acute illness is indeed a protective physiological response or a therapeutic target needing early corrective nutritional therapy is a matter of current debate and can only be resolved within a large and well-designed randomised controlled trial comparing early nutritional therapy with "appetite-guided" nutrition in this patient population. Apart from in critical care, where various large trials have recently been published, there is an important lack of high quality data from large randomised trials in unselected acutely ill medical inpatients to support the early use of nutritional therapy, to shed light on the optimal type, caloric amount and timing of nutritional therapy and to answer ultimately the question as to which patient population will in fact benefit from nutritional interventions. Currently, the EFFORT trial is enrolling patients and aims to fill these literature gaps. The aim of this review is to discuss the current evidence regarding nutritional therapy in acutely ill medical inpatients, and to recommend whether or not, based on today's available evidence, physician should indeed encourage their malnourished patients to "…finish their lunch". PMID:25906253

  6. [Geriatric traumatology - vision or reality?].

    PubMed

    Koudela, Karel; Kasal, E; Matejka, J; Vyskocil, V

    2009-08-01

    The aim of the paper is to provide information on the establishment of the Geriatric Fracture Centre (GFC) at the Department of Orthopaedics and Traumatology, Faculty Hospital at the Faculty of Medicine, Charles University, Pilsner, whose goals and services are in accordance with the principles of the Rochester GFC, USA, and the AO Foundation at Synthes Inc. The paper presents up-to-date information on the methods of osteosynthesis for the skeletal system affected by osteoporosis, the majority of which was obtained in the AO Geriatric Fracture Course in Davos, December 2007. The authors are concerned with the pre-operative examination of geriatric patients who suffered a fracture.The anaesthesiologist's view on our elderly patients, their pre-operative preparation, anaesthesia application and post-operative care are presented.The novel method of two-phase bone densitometry and its role in the therapy of osteoporosis for elderly patients with fractures are also mentioned. PMID:19755061

  7. Geriatric assessment for oncologists

    PubMed Central

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

    2015-01-01

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

  8. History of geriatrics in Canada.

    PubMed

    Hogan, David B

    2007-01-01

    Specialization is a pervasive movement in medicine. How specialties develop is a complex phenomenon and does not depend solely on the growth of knowledge. The history of geriatrics in Canada is presented as an example of specialization in our country. The gestation period extended over decades. Practitioners moved from partial specialization to a full-time practice in the care of older patients. Opposition to the emerging specialty was mounted by established fields of practice. The choices made by the leaders of Canadian geriatrics molded the evolution of the specialty and have contributed to its precarious status at the present time.

  9. Risk factors for early readmission to acute care for persons with schizophrenia taking antipsychotic medications.

    PubMed

    Boaz, Timothy L; Becker, Marion Ann; Andel, Ross; Van Dorn, Richard A; Choi, Jiyoon; Sikirica, Mirko

    2013-12-01

    OBJECTIVE The study examined risk factors for readmission to acute care among Florida Medicaid enrollees with schizophrenia treated with antipsychotics. METHODS Medicaid and service use data for 2004 to 2008 were used to identify adults with schizophrenia discharged from hospitals and crisis units who were taking antipsychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care. Cox proportional hazards regression estimated readmission risk in the 30 days after discharge and in the period after 30 days for participants not readmitted in the first 30 days. RESULTS The mean±SD age of the 3,563 participants was 43.4±11.1; 61% were male, and 38% were white. Participants had 6,633 inpatient episodes; duration of hospitalization was 10.6±7.0 days. Readmission occurred for 84% of episodes, 23% within 30 days. Variables associated with an increased readmission risk in the first 30 days were shorter hospitalization (hazard ratio [HR]=1.18, 95% confidence interval [CI]=1.10-1.27, p<.001), shorter time on medication before discharge (HR=1.19, CI=1.06-1.35, p=.003), greater prehospitalization use of acute care (HR=2.64, CI=2.29-3.05, p<.001), serious general medical comorbidity (HR=1.21, CI=1.06-1.38, p=.005), and prior substance abuse treatment (HR=1.58, CI=1.37-1.83, p<.001). After 30 days, hospitalization duration and time on medication were not significant risk factors. CONCLUSIONS Short hospital stays for persons with schizophrenia may be associated with risk of early readmission, possibly because the person is insufficiently stabilized. More chronic risk factors include prior acute care, general medical comorbidity, and substance abuse. PMID:23945797

  10. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William R; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-12-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49.

  11. Geriatric Optometry Programs of Promise.

    ERIC Educational Resources Information Center

    Verma, Satya B.

    1985-01-01

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

  12. Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters

    PubMed Central

    Debacker, Michel; Hubloue, Ives; Dhondt, Erwin; Rockenschaub, Gerald; Rüter, Anders; Codreanu, Tudor; Koenig, Kristi L.; Schultz, Carl; Peleg, Kobi; Halpern, Pinchas; Stratton, Samuel; Della Corte, Francesco; Delooz, Herman; Ingrassia, Pier Luigi; Colombo, Davide; Castrèn, Maaret

    2012-01-01

    Background: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. Methods: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. Results: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. Conclusion: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims. PMID:23066513

  13. Medication Literacy in a Cohort of Chinese Patients Discharged with Acute Coronary Syndrome

    PubMed Central

    Zhong, Zhuqing; Zheng, Feng; Guo, Yuna; Luo, Aijing

    2016-01-01

    This study aims at investigating medication literacy of discharged patients with acute coronary syndrome (ACS) in China, and the important determinants of medication literacy among them. For this purpose, we conducted a prospective cohort study. Patient’s demographic and clinical data were retrieved from hospital charts and medication literacy was measured by instructed interview using the Chinese version of Medication Literacy Questionnaire on Discharged Patient between 7 and 30 days after the patient was discharged from the hospital. The results show that medication literacy for the surveyed patients was insufficient: >20% did not have adequate knowledge on the types of drugs and the frequency that they need to take the drugs, >30% did not know the name of and the dosage of the drugs they are taking, and >70% did not have adequate knowledge on the effects and side effects of the drugs they are taking. Our research indicated that medication literacy scores decreased with age but increased with education. The number of medicines the discharged patient took with them and days between discharge and interview were not associated with medication literacy levels. PMID:27428990

  14. Medication Literacy in a Cohort of Chinese Patients Discharged with Acute Coronary Syndrome.

    PubMed

    Zhong, Zhuqing; Zheng, Feng; Guo, Yuna; Luo, Aijing

    2016-07-15

    This study aims at investigating medication literacy of discharged patients with acute coronary syndrome (ACS) in China, and the important determinants of medication literacy among them. For this purpose, we conducted a prospective cohort study. Patient's demographic and clinical data were retrieved from hospital charts and medication literacy was measured by instructed interview using the Chinese version of Medication Literacy Questionnaire on Discharged Patient between 7 and 30 days after the patient was discharged from the hospital. The results show that medication literacy for the surveyed patients was insufficient: >20% did not have adequate knowledge on the types of drugs and the frequency that they need to take the drugs, >30% did not know the name of and the dosage of the drugs they are taking, and >70% did not have adequate knowledge on the effects and side effects of the drugs they are taking. Our research indicated that medication literacy scores decreased with age but increased with education. The number of medicines the discharged patient took with them and days between discharge and interview were not associated with medication literacy levels.

  15. The quality of patient experience of short-stay acute medical admissions: findings of the Adult Inpatient Survey in England.

    PubMed

    Sullivan, Paul; Harris, Mary L; Bell, Derek

    2013-12-01

    Introduction of the specialty of acute medicine and of acute medical units (AMUs) in the UK have been associated with improvements in mortality, length of stay and flow, but there is no literature on the patient experience during the early phase of acute medical admissions. We analysed the Adult Inpatient Survey (AIPS) findings for short-stay unscheduled medical admissions who did not move from their first admission ward (n=3325) and therefore are likely to have been managed entirely in the AMU. We compared these with short-stay emergencies in other specialties (n=3420) and short-stay scheduled admissions (n=10,347). Scheduled admissions reported a better experience for all survey items. Scores for unscheduled admissions were worse in medical patients compared with other specialties for pain control, privacy, involvement, information, and for a number of questions relating to information on discharge. The specialty of acute medicine should work to improve future patient experience.

  16. Objective Structured Video Examinations (OSVEs) for geriatrics education.

    PubMed

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

    2006-01-01

    The Medical College of Wisconsin (MCW) and the Wisconsin Geriatric Education Center (WGEC) are committed to developing educational materials for primary care physicians in training. In response to the opportunity created by the Accreditation Council for Graduate Medical Education (ACGME) competency mandate, an MCW-led interdisciplinary working group has developed competency-linked video-based assessment tools for use in primary care residency training programs. Modeled after the Objective Structured Clinical Examinations (OSCE), used as part of the medical licensing examination process, we created geriatric-focused Objective Structured Video Examinations (OSVEs) as a strategy to infuse geriatrics into residency training. Each OSVE tool contains a 1-3 minute video trigger that is associated with a series of multiple choice and/or constructed response questions (e.g., fill in the blank). These questions assess residents' understanding of video-demonstrated ACGME competencies including professionalism, systems-based practice, communication, and practice-based learning. An instructor's guide and scoring key are provided for each tool. Response to the OSVEs has been overwhelmingly enthusiastic including greater than 90% commitment by statewide faculty to use the tools in residency training.

  17. Medical relief activities conducted by Nippon Medical School in the acute phase of the Great East Japan Earthquake 2011.

    PubMed

    Fuse, Akira; Shuto, Yuki; Ando, Fumihiko; Shibata, Masafumi; Watanabe, Akihiro; Onda, Hidetaka; Masuno, Tomohiko; Yokota, Hiroyuki

    2011-01-01

    At 14:46 on March 11, 2011, the Great East Japan Earthquake and tsunami occurred off the coast of Honshu, Japan. In the acute phase of this catastrophe, one of our teams was deployed as a Tokyo Disaster Medical Assistance Team (DMAT) to Kudan Kaikan in Tokyo, where the ceiling of a large hall had partially collapsed as the result of the earthquake, to conduct triage at the scene: 6 casualties were assigned to the red category (immediate), which included 1 case of cardiopulmonary arrest and 1 of flail chest; 8 casualties in the yellow category (delayed); and 22 casualties in the green category (minor). One severely injured person was transported to our hospital. Separately, our medical team was deployed to Miyagi 2 hours after the earthquake in our multipurpose medical vehicle as part of Japan DMAT (J-DMAT). We were the first DMAT from the metropolitan area to arrive, but we were unable to start medical relief activities because the information infrastructure had been destroyed and no specific information had yet reached the local headquarters. Early next morning, J-DMAT decided to support Sendai Medical Center and search and rescue efforts in the affected area and to establish a staging care unit at Camp Kasuminome of the Japan Self-Defense Force. Our team joined others to establish the staging care unit. Because information was still confused until day 3 of the disaster and we could not adequately grasp onsite medical needs, our J-DMAT decided to provide onsite support at Ishinomaki Red Cross Hospital, a disaster base hospital, and relay information about its needs to the local J-DMAT headquarters. Although our medical relief teams were deployed as quickly as possible, we could not begin medical relief activities immediately owing to the severely damaged information infrastructure. Only satellite mobile phones could be operated, and information on the number of casualties and the severity of shortages of lifeline services could be obtained only through a "go and

  18. Medical relief activities conducted by Nippon Medical School in the acute phase of the Great East Japan Earthquake 2011.

    PubMed

    Fuse, Akira; Shuto, Yuki; Ando, Fumihiko; Shibata, Masafumi; Watanabe, Akihiro; Onda, Hidetaka; Masuno, Tomohiko; Yokota, Hiroyuki

    2011-01-01

    At 14:46 on March 11, 2011, the Great East Japan Earthquake and tsunami occurred off the coast of Honshu, Japan. In the acute phase of this catastrophe, one of our teams was deployed as a Tokyo Disaster Medical Assistance Team (DMAT) to Kudan Kaikan in Tokyo, where the ceiling of a large hall had partially collapsed as the result of the earthquake, to conduct triage at the scene: 6 casualties were assigned to the red category (immediate), which included 1 case of cardiopulmonary arrest and 1 of flail chest; 8 casualties in the yellow category (delayed); and 22 casualties in the green category (minor). One severely injured person was transported to our hospital. Separately, our medical team was deployed to Miyagi 2 hours after the earthquake in our multipurpose medical vehicle as part of Japan DMAT (J-DMAT). We were the first DMAT from the metropolitan area to arrive, but we were unable to start medical relief activities because the information infrastructure had been destroyed and no specific information had yet reached the local headquarters. Early next morning, J-DMAT decided to support Sendai Medical Center and search and rescue efforts in the affected area and to establish a staging care unit at Camp Kasuminome of the Japan Self-Defense Force. Our team joined others to establish the staging care unit. Because information was still confused until day 3 of the disaster and we could not adequately grasp onsite medical needs, our J-DMAT decided to provide onsite support at Ishinomaki Red Cross Hospital, a disaster base hospital, and relay information about its needs to the local J-DMAT headquarters. Although our medical relief teams were deployed as quickly as possible, we could not begin medical relief activities immediately owing to the severely damaged information infrastructure. Only satellite mobile phones could be operated, and information on the number of casualties and the severity of shortages of lifeline services could be obtained only through a "go and

  19. Pediatric Medical Care System in China Has Significantly Reduced Abandonment of Acute Lymphoblastic Leukemia Treatment.

    PubMed

    Zhou, Qi; Hong, Dan; Lu, Jun; Zheng, Defei; Ashwani, Neetica; Hu, Shaoyan

    2015-04-01

    In this study, we have analyzed both administrative and clinical data from our hospital during 2002 to 2012 to evaluate the influence of government medical policies on reducing abandonment treatment in pediatric patients with acute lymphoblastic leukemia. Two policies funding for the catastrophic diseases and the new rural cooperative medical care system (NRCMS) were initiated in 2005 and 2011, respectively. About 1151 children diagnosed with acute lymphoblastic leukemia were enrolled in our study during this period and 316 cases abandoned treatment. Statistical differences in sex, age, number of children in the family, and family financial status were observed. Of most importance, the medical insurance coverage was critical for reducing abandonment treatment. However, 92 cases abandoning treatment after relapse did not show significant difference either in medical insurance coverage or in duration from first complete remission. In conclusion, financial crisis was the main reason for abandoning treatment. Government-funded health care expenditure programs reduced families' economic burden and thereby reduced the abandonment rate with resultant increased overall survival.

  20. Pediatric Medical Care System in China Has Significantly Reduced Abandonment of Acute Lymphoblastic Leukemia Treatment

    PubMed Central

    Zhou, Qi; Hong, Dan; Lu, Jun; Zheng, Defei; Ashwani, Neetica

    2015-01-01

    In this study, we have analyzed both administrative and clinical data from our hospital during 2002 to 2012 to evaluate the influence of government medical policies on reducing abandonment treatment in pediatric patients with acute lymphoblastic leukemia. Two policies funding for the catastrophic diseases and the new rural cooperative medical care system (NRCMS) were initiated in 2005 and 2011, respectively. About 1151 children diagnosed with acute lymphoblastic leukemia were enrolled in our study during this period and 316 cases abandoned treatment. Statistical differences in sex, age, number of children in the family, and family financial status were observed. Of most importance, the medical insurance coverage was critical for reducing abandonment treatment. However, 92 cases abandoning treatment after relapse did not show significant difference either in medical insurance coverage or in duration from first complete remission. In conclusion, financial crisis was the main reason for abandoning treatment. Government-funded health care expenditure programs reduced families’ economic burden and thereby reduced the abandonment rate with resultant increased overall survival. PMID:25393454

  1. Pharmacokinetics and interactions of headache medications, part I: introduction, pharmacokinetics, metabolism and acute treatments.

    PubMed

    Sternieri, Emilio; Coccia, Ciro Pio Rosario; Pinetti, Diego; Ferrari, Anna

    2006-12-01

    Recent progress in the treatment of primary headaches has made available specific, effective and safe medications for these disorders, which are widely spread among the general population. One of the negative consequences of this undoubtedly positive progress is the risk of drug-drug interactions. This review is the first in a two-part series on pharmacokinetic drug-drug interactions of headache medications. Part I addresses acute treatments. Part II focuses on prophylactic treatments. The overall aim of this series is to increase the awareness of physicians, either primary care providers or specialists, regarding this topic. Pharmacokinetic drug-drug interactions of major severity involving acute medications are a minority among those reported in literature. The main drug combinations to avoid are: i) NSAIDs plus drugs with a narrow therapeutic range (i.e., digoxin, methotrexate, etc.); ii) sumatriptan, rizatriptan or zolmitriptan plus monoamine oxidase inhibitors; iii) substrates and inhibitors of CYP2D6 (i.e., chlorpromazine, metoclopramide, etc.) and -3A4 (i.e., ergot derivatives, eletriptan, etc.), as well as other substrates or inhibitors of the same CYP isoenzymes. The risk of having clinically significant pharmacokinetic drug-drug interactions seems to be limited in patients with low frequency headaches, but could be higher in chronic headache sufferers with medication overuse. PMID:17125411

  2. Interactive Algorithms for Teaching and Learning Acute Medicine in the Network of Medical Faculties MEFANET

    PubMed Central

    Štourač, Petr; Komenda, Martin; Harazim, Hana; Kosinová, Martina; Gregor, Jakub; Hůlek, Richard; Smékalová, Olga; Křikava, Ivo; Štoudek, Roman; Dušek, Ladislav

    2013-01-01

    Background Medical Faculties Network (MEFANET) has established itself as the authority for setting standards for medical educators in the Czech Republic and Slovakia, 2 independent countries with similar languages that once comprised a federation and that still retain the same curricular structure for medical education. One of the basic goals of the network is to advance medical teaching and learning with the use of modern information and communication technologies. Objective We present the education portal AKUTNE.CZ as an important part of the MEFANET’s content. Our focus is primarily on simulation-based tools for teaching and learning acute medicine issues. Methods Three fundamental elements of the MEFANET e-publishing system are described: (1) medical disciplines linker, (2) authentication/authorization framework, and (3) multidimensional quality assessment. A new set of tools for technology-enhanced learning have been introduced recently: Sandbox (works in progress), WikiLectures (collaborative content authoring), Moodle-MEFANET (central learning management system), and Serious Games (virtual casuistics and interactive algorithms). The latest development in MEFANET is designed for indexing metadata about simulation-based learning objects, also known as electronic virtual patients or virtual clinical cases. The simulations assume the form of interactive algorithms for teaching and learning acute medicine. An anonymous questionnaire of 10 items was used to explore students’ attitudes and interests in using the interactive algorithms as part of their medical or health care studies. Data collection was conducted over 10 days in February 2013. Results In total, 25 interactive algorithms in the Czech and English languages have been developed and published on the AKUTNE.CZ education portal to allow the users to test and improve their knowledge and skills in the field of acute medicine. In the feedback survey, 62 participants completed the online questionnaire (13

  3. Nurses' perceptions of how physical environment affects medication errors in acute care settings.

    PubMed

    Mahmood, Atiya; Chaudhury, Habib; Valente, Maria

    2011-11-01

    The work that nurses perform in hospital environments is physically and psychologically intense, with the potential for burnout and stress. This issue is compounded by crowded and poorly designed work spaces in nursing units that can contribute to medical mistakes, including medication errors. This article is based on a study that examined the nurses' perception of how the physical environment in hospitals affects medication errors. Literature suggests that reduction of staff stress can be achieved through physical environmental considerations, such as improved air quality, acoustics, and lighting. However, there is no empirical study specifically exploring the relationship between aspects of the physical environment and medication errors. In this study, a cross-sectional survey was conducted with nursing staff (N = 84) in four hospitals in the Pacific Northwest region of the United States. The survey included questions on nursing unit design, medication room configurations, perceived incidence of errors, and adverse events. Respondents noted several physical environmental factors that are potentially problematic in the nursing station area and can lead to medication, documentation, and other types of nursing errors. These factors include inadequate space in charting and documentation area, lengthy walking distances to patient rooms, insufficient patient surveillance opportunity/lack of visibility to all parts of the nursing unit, small size of the medication room, inappropriate organization of medical supplies, high noise levels in nursing unit, poor lighting, and lack of privacy in the nursing stations. As administrators in acute care facilities consider strategies for organizational and staff interventions to reduce medication errors, it is important to consider physical environmental factors to have a comprehensive understanding of the issue.

  4. Thrombo-prophylaxis in acutely ill medical and critically ill patients.

    PubMed

    Saigal, Saurabh; Sharma, Jai Prakash; Joshi, Rajnish; Singh, Dinesh Kumar

    2014-06-01

    Thrombo-prophylaxis has been shown to reduce the incidence of pulmonary embolism (PE) and mortality in surgical patients. The purpose of this review is to find out the evidence-based clinical practice criteria of deep vein thrombosis (DVT) prophylaxis in acutely ill medical and critically ill patients. English-language randomized controlled trials, systematic reviews, and meta-analysis were included if they provided clinical outcomes and evaluated therapy with low-dose heparin or related agents compared with placebo, no treatment, or other active prophylaxis in the critically ill and medically ill population. For the same, we searched MEDLINE, PUBMED, Cochrane Library, and Google Scholar. In acutely ill medical patients on the basis of meta-analysis by Lederle et al. (40 trials) and LIFENOX study, heparin prophylaxis had no significant effect on mortality. The prophylaxis may have reduced PE in acutely ill medical patients, but led to more bleeding events, thus resulting in no net benefit. In critically ill patients, results of meta-analysis by Alhazzani et al. and PROTECT Trial indicate that any heparin prophylaxis compared with placebo reduces the rate of DVT and PE, but not symptomatic DVT. Major bleeding risk and mortality rates were similar. On the basis of MAGELLAN trial and EINSTEIN program, rivaroxaban offers a single-drug approach to the short-term and continued treatment of venous thrombosis. Aspirin has been used as antiplatelet agent, but when the data from two trials the ASPIRE and WARFASA study were pooled, there was a 32% reduction in the rate of recurrence of venous thrombo-embolism and a 34% reduction in the rate of major vascular events.

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

    PubMed Central

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

    2014-01-01

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

  6. [The seal of quality in geriatrics].

    PubMed

    Gogol, M; Luettje, D

    2007-06-01

    In autumn 2005, the Geriatric and Gerontological Scientific Societies together with the Organisation of Geriatric Departments developed a quality seal in a discussion process over about 18 months. The needs to be addressed were corporate development, allocation through an independent and external institution for quality management, consideration of the heterogeneous German structure of geriatric medicine, independence of specific conditions and the consideration of 20 years of geriatric medicine practise in Germany. The seal is specific for geriatric medicine and assumes successful certification in general quality management. It describes the needs in the area of structure, process and outcome quality. Since introduction, 12 geriatric departments (as of March 2007) have been successfully certified. PMID:17565431

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

    PubMed

    Saint-Jean, O; LeGuen, J

    2015-10-01

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

  8. ETHICS IN GERIATRIC MEDICINE RESEARCH

    PubMed Central

    İlgili, Önder; Arda, Berna; Munir, Kerim

    2014-01-01

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

  9. Rhinitis in the geriatric population

    PubMed Central

    2010-01-01

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

  10. ETHICS IN GERIATRIC MEDICINE RESEARCH.

    PubMed

    Ilgili, Onder; Arda, Berna; Munir, Kerim

    2014-01-01

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

  11. Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens

    PubMed Central

    Lambert-Kerzner, Anne; Havranek, Edward P; Plomondon, Mary E; Fagan, Katherine M; McCreight, Marina S; Fehling, Kelty B; Williams, David J; Hamilton, Alison B; Albright, Karen; Blatchford, Patrick J; Mihalko-Corbitt, Renee; Bryson, Chris L; Bosworth, Hayden B; Kirshner, Miriam A; Giacco, Eric J Del; Ho, P Michael

    2015-01-01

    Purpose Poor adherence to cardioprotective medications after acute coronary syndrome (ACS) hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients’ perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients’ perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. Patients and methods Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were analyzed using the constant comparative approach. Results Participants described their post-ACS event experiences and how they affected their adherence behaviors. Patients reported that adherence decisions were facilitated by mutually respectful and collaborative provider–patient treatment planning. Frequent interactions with providers and medication refill reminder calls supported improved adherence. Additional facilitators included having social support, adherence routines, and positive attitudes toward an ACS event. The majority of patients expressed that being active participants in health care decision-making contributed to their health. Conclusion Our findings demonstrate that respectful collaborative communication can contribute to medication adherence after ACS hospitalization. These results suggest a potential role for training health-care providers, including pharmacists, social workers, registered nurses, etc, to elicit and acknowledge the patients’ views regarding medication

  12. An interactional structure of medical activities during acute visits and its implications for patients' participation.

    PubMed

    Robinson, Jeffrey D

    2003-01-01

    Within the context of primary-care, physician-patient visits, researchers have documented both patients' low levels of communicative participation (e.g., question asking) and the advantages of such participation to healthcare (e.g., improved physical health and satisfaction). Prior research has offered a variety of partial, non-exclusive explanations for patients' low levels of participation. This article investigates one underdeveloped source of explanation: the organization of interaction itself. This article argues that the establishment of new medical problems in acute visits makes relevant an organized structure of social action that is composed of an ordered series of medical activities: establishing the reason for the visit, physicians gathering additional information (i.e., history taking and physical examination), physicians delivering diagnoses, and physicians providing treatment recommendations. This "project" of medical activity shapes physicians' and patients' understanding and production of communicative behavior. Using the method of conversation analysis, and analyzing transcribed audio- and videotape data of actual acute visits, this article describes and grounds this project and discusses its implications for research, theory, and improvement on patient participation.

  13. [Geriatrics and gerontology in Senegal].

    PubMed

    Coumé, Mamadou; Touré, Kamadore; Faye, Atoumane; Moreira, Therese Diop

    2013-01-01

    Senegal is dealing positively with its demographic transition. On September 1st 2006, the Senegalese government introduced the "Plan Sesame", a national free health care program for elderly people aged 60 years and over. The University of Dakar academic authorities support the Sesame plan through an innovative training program in geriatrics and gerontology. Such programs aim to address the challenge of ageing in a developing country.

  14. Factors Associated with Follow-Up Attendance among Rape Victims Seen in Acute Medical Care

    PubMed Central

    Darnell, Doyanne; Peterson, Roselyn; Berliner, Lucy; Stewart, Terri; Russo, Joan; Whiteside, Lauren; Zatzick, Douglas

    2016-01-01

    Objective Rape is associated with Posttraumatic Stress Disorder and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well-positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Method Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Results Of the 521 diverse female (n=476) and male (n=45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR=0.40, 95% CI=0.21-0.77), having a current mental illness (OR=0.25, 95% CI=0.13-0.49), and being assaulted in public (OR=0.50, 95% CI=0.28-0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR= 3.02 95% CI=1.86-4.91), a completed SANE examination (OR=2.97, 95% CI=1.84-4.81), and social support available to help cope with the assault (OR=3.54, 95% CI=1.76-7.11) were associated with an increased odds of attending the follow-up. Conclusions Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage among these patients is warranted and may require alternative models to engage these patients to support posttraumatic recovery. PMID:26168030

  15. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update.

    PubMed

    Luks, Andrew M; McIntosh, Scott E; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Schoene, Robert B; Zafren, Ken; Hackett, Peter H

    2014-12-01

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.

  16. [Pain Management in geriatric patients].

    PubMed

    Eiche, Jürgen; Schache, Florian

    2016-04-01

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

  17. E-learning virtual patients for geriatric education.

    PubMed

    Orton, Eric; Mulhausen, Paul

    2008-01-01

    Computer-based virtual patients (VPs) are an emerging medium for medical education that addresses barriers faced by geriatrics educators. Research has shown VPs to be as effective in changing knowledge and behavior as more traditional forms of teaching. This paper presents a descriptive study of the development of the University of Iowa's GeriaSims VP programs and their effectiveness as tools for geriatric education. More than 85% of the responses to an evaluation survey of GeriaSims users indicated favorable perceptions of instructional effectiveness, efficiency, and ease of use. GeriaSims VP programs were used effectively by multiple levels of learners and provide flexibility to these learners in scheduling their learning. PMID:18215989

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

    ERIC Educational Resources Information Center

    Barolin, G. S.

    1996-01-01

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

  19. Acute care nurse practitioners: creating and implementing a model of care for an inpatient general medical service.

    PubMed

    Howie, Jill N; Erickson, Mitchel

    2002-09-01

    Changes in medical education and healthcare reimbursement are recent threats to most academic medical centers' dual mission of patient care and education. Financial pressures stem from reduced insurance reimbursement, capitation, and changes in public funding for medical residency education. Pressures for innovation result from increasing numbers of patients, higher acuity of patients, an aging population of patients with complex problems, and restrictions on residency workloads. A framework for addressing the need for innovation in the medical service at a large academic medical center is presented. The framework enables acute care nurse practitioners to provide inpatient medical management in collaboration with a hospitalist. The model's development, acceptance, successes, pitfalls, and evaluation are described. The literature describing the use of nurse practitioners in acute care settings is reviewed.

  20. A Model Intensive Course in Geriatric Teaching for Non-geriatrician Educators

    PubMed Central

    Park, EunMi; Schmaltz, Heidi; Gozu, Aysegul; Durso, Samuel C.

    2008-01-01

    Summary Introduction Because of the aging demographics nearly all medical specialties require faculty who are competent to teach geriatric care principles to learners, yet many non-geriatrician physician faculty members report they are not prepared for this role. Aims To determine the impact of a new educational intervention designed to improve the self-efficacy and ability of non-geriatrician clinician-educators to teach geriatric medicine principles to medical students and residents. Description Forty-two non-geriatrician clinician-educator faculty from17 academic centers self-selected to participate in a 3-day on-site interactive intensive course designed to increase knowledge of specific geriatric medicine principles and to enhance teaching efficacy followed by up to a year of mentorship by geriatrics faculty after participants return to their home institutions. On average, 24% of their faculty time was spent teaching and 57% of their clinical practices involved patients aged over 65 years. Half of all participants were in General Internal Medicine, and the remaining were from diverse areas of medicine. Evaluation Tests of geriatrics medical knowledge and attitudes were high at baseline and did not significantly change after the intervention. Self-rated knowledge about specific geriatric syndromes, self-efficacy to teach geriatrics, and reported value for learning about geriatrics all improved significantly after the intervention. A quarter of the participants reported they had achieved at least one of their self-selected 6-month teaching goals. Discussion An intensive 3-day on-site course was effective in improving self-reported knowledge, value, and confidence for teaching geriatrics principles but not in changing standardized tests of geriatrics knowledge and attitudes in a diverse group of clinician-educator faculty. This intervention was somewhat associated with new teaching behaviors 6 months after the intervention. Longer-term investigations are

  1. Allergie acute contact dermatitis due to Arnica tincture self-medication.

    PubMed

    Hörmann, H P; Korting, H C

    1995-04-01

    After repeated intermittent use of Arnica tincture for rosacea a 66-year-old patient developed acute allergic contact dermatitis with blistering upon the single application of Arnica tincture to the dorsum of the right hand for minor swelling. Contact allergy of the delayed type to Arnica tincture could be proven by patch testing. Early diagnosis and treatment prevented exacerbation and spreading of the disease. In view of the wide use of Arnica preparations, particularly for self-medication, and the notable sensitizing potential, Arnica tincture should be a regular component of patch test series, at least when drug allergy is suspected.

  2. Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

    PubMed Central

    Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L

    1989-01-01

    We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care. PMID:2504064

  3. Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

    PubMed

    Kane, R L; Garrard, J; Skay, C L; Radosevich, D M; Buchanan, J L; McDermott, S M; Arnold, S B; Kepferle, L

    1989-09-01

    We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

  4. Antipsychotic Medications and Risk of Acute Coronary Syndrome in Schizophrenia: A Nested Case-Control Study

    PubMed Central

    Liu, Hsing-Cheng; Yang, Shu-Yu; Liao, Ya-Tang; Chen, Chiao-Chicy; Kuo, Chian-Jue

    2016-01-01

    Background This study assessed the risk of developing acute coronary syndrome requiring hospitalization in association with the use of certain antipsychotic medications in schizophrenia patients. Methods A nationwide cohort of 31,177 inpatients with schizophrenia between the ages of 18 and 65 years whose records were enrolled in the National Health Insurance Research Database in Taiwan from 2000 to 2008 and were studied after encrypting the identifications. Cases (n = 147) were patients with subsequent acute coronary syndrome requiring hospitalization after their first psychiatric admission. Based on a nested case-control design, each case was matched with 20 controls for age, sex and the year of first psychiatric admission using risk-set sampling. The effects of antipsychotic agents on the development of acute coronary syndrome were assessed using multiple conditional logistic regression and sensitivity analyses to confirm any association. Results We found that current use of aripiprazole (adjusted risk ratio [RR] = 3.68, 95% CI: 1.27–10.64, p<0.05) and chlorpromazine (adjusted RR = 2.96, 95% CI: 1.40–6.24, p<0.001) were associated with a dose-dependent increase in the risk of developing acute coronary syndrome. Although haloperidol was associated with an increased risk (adjusted RR = 2.03, 95% CI: 1.20–3.44, p<0.01), there was no clear dose-dependent relationship. These three antipsychotic agents were also associated with an increased risk in the first 30 days of use, and the risk decreased as the duration of therapy increased. Sensitivity analyses using propensity score-adjusted modeling showed that the results were similar to those of multiple regression analysis. Conclusions Patients with schizophrenia who received aripiprazole, chlorpromazine, or haloperidol could have a potentially elevated risk of developing acute coronary syndrome, particularly at the start of therapy. PMID:27657540

  5. Secure Internet video conferencing for assessing acute medical problems in a nursing facility.

    PubMed Central

    Weiner, M.; Schadow, G.; Lindbergh, D.; Warvel, J.; Abernathy, G.; Dexter, P.; McDonald, C. J.

    2001-01-01

    Although video-based teleconferencing is becoming more widespread in the medical profession, especially for scheduled consultations, applications for rapid assessment of acute medical problems are rare. Use of such a video system in a nursing facility may be especially beneficial, because physicians are often not immediately available to evaluate patients. We have assembled and tested a portable, wireless conferencing system to prepare for a randomized trial of the system s influence on resource utilization and satisfaction. The system includes a rolling cart with video conferencing hardware and software, a remotely controllable digital camera, light, wireless network, and battery. A semi-automated paging system informs physicians of patient s study status and indications for conferencing. Data transmission occurs wirelessly in the nursing home and then through Internet cables to the physician s home. This provides sufficient bandwidth to support quality motion images. IPsec secures communications. Despite human and technical challenges, this system is affordable and functional. Images Figure 1 PMID:11825286

  6. Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Acute Care Medications

    PubMed Central

    Rowe, Stevie; Siegel, David; Benjamin, Daniel K.

    2015-01-01

    Purpose Approximately 1 out of 6 children in the United States is obese. This has important implications for drug dosing and safety, as pharmacokinetic (PK) changes are known to occur in obesity due to altered body composition and physiology. Inappropriate drug dosing can limit therapeutic efficacy and increase drug-related toxicity for obese children. Few systematic reviews examining PK and drug dosing in obese children have been performed. Methods We identified 25 acute care drugs from the Strategic National Stockpile and Acute Care Supportive Drugs List and performed a systematic review for each drug in 3 study populations: obese children (2–18 years of age), normal weight children, and obese adults. For each study population, we first reviewed a drug’s Food and Drug Administration (FDA) label, followed by a systematic literature review. From the literature, we extracted drug PK data, biochemical properties, and dosing information. We then reviewed data in 3 age subpopulations (2–7 years, 8–12 years, and 13–18 years) for obese and normal weight children and by route of drug administration (intramuscular, intravenous, by mouth, and inhaled). If sufficient PK data were not available by age/route of administration, a data gap was identified. Findings Only 2/25 acute care drugs (8%) contained dosing information on the FDA label for each obese children and adults compared with 22/25 (88%) for normal weight children. We found no sufficient PK data in the literature for any of the acute care drugs in obese children. Sufficient PK data were found for 7/25 acute care drugs (28%) in normal weight children and 3/25 (12%) in obese adults. Implications Insufficient information exists to guide dosing in obese children for any of the acute care drugs reviewed. This knowledge gap is alarming, given the known PK changes that occur in the setting of obesity. Future clinical trials examining the PK of acute care medications in obese children should be prioritized. PMID

  7. Teaching evidence-based nursing practice in geriatric care settings: the geriatric nursing innovations through education institute.

    PubMed

    McConnell, Eleanor S; Lekan, Deborah; Bunn, Melanie; Egerton, Emily; Corazzini, Kirsten N; Hendrix, Cristina D; Bailey, Donald E

    2009-04-01

    Evidence-based practice holds tremendous potential to optimize care outcomes for older adults, yet many nurses are ill prepared to identify, interpret, and apply the best evidence to their practice. The Geriatric Nursing Innovations through Education (GNIE) Institute is a 39-contact-hour, hybrid distance learning continuing education model designed to strengthen RNs'clinical knowledge, leadership skills, and capacity for implementing evidence-based geriatric care. The GNIE Institute combines reflective, learner-centered instructional approaches with a practicum during which evidence-based guidelines are implemented.The experiences of 128 RNs suggest that the GNIE Institute supports the implementation of a variety of best practices, including management of acute pain, dehydration, delirium, oral hygiene, urinary incontinence, and falls prevention. Participant feedback has shown low initial awareness of practice guidelines but high satisfaction with their use. The GNIE Institute thus represents a viable model for building the capacity of practicing RNs to implement evidence-based approaches to the care of geriatric syndromes across the care continuum.

  8. Report: trends in adherence to secondary prevention medications in post-acute coronary syndrome patients.

    PubMed

    Kassab, Yaman Walid; Hassan, Yahaya; Aziz, Noorizan Abd; Zulkifly, Hanis Hanum; Iqbal, Muhammad Shahid

    2015-03-01

    To evaluate patients' adherence to evidence-based therapies at an average of 2 years after discharge for Acute Coronary Syndrome (ACS) and to identify factors associated with non-adherence. This study was conducted at Hospital Pulau Pinang, Malaysia. A random sample of ACS patients (n=190) who had discharged on a regimen of secondary preventive medications were included and followed up over a three follow-up appointments at 8, 16, and 23 months post discharge. At each appointment, patients were interviewed and given Morisky questioner to complete in order to compare their level of adherence to the prescribed regimens across the three consecutive time periods. Majority of patients reported either medium or low adherence across the three time periods with only small portion reported high adherence. Furthermore, there was a significant downward trend in the level of adherence to cardio protective medications during the study period (p<0.001). This study also identified 6 factors-age, gender, employment status, ACS subtype, number of co morbidities and number of prescription medications per day that may influence Patients' adherence to their medications. Our findings suggest that long-term adherence to secondary prevention therapies among patients with ACS in Malaysia is sub optimal and influenced by many demographic, social as well as clinical factors.

  9. Enhancing Geriatric Curriculum in Nursing School

    ERIC Educational Resources Information Center

    Collins, Kevin

    2013-01-01

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

  10. Trends in Predoctoral Education in Geriatric Dentistry.

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  11. Teaching geriatrics using an innovative, individual-centered educational game: students and educators win. A proof-of-concept study.

    PubMed

    van de Pol, Marjolein H J; Lagro, Joep; Fluit, Lia R M G; Lagro-Janssen, Toine L M; Olde Rikkert, Marcel G M

    2014-10-01

    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.

  12. Structural Neuroimaging of Geriatric Depression

    PubMed Central

    Benjamin, Sophiya; Steffens, David C

    2013-01-01

    There is a large literature on the neuroanatomy of late-life depression which continues to grow with the discovery of novel structural imaging techniques along with innovative methods to analyze the images. Such advances have helped identify specific areas as well characteristic lesions in the brain and changes in the chemical composition in these regions that might be important in the pathophysiology of this complex disease. In this article we review the relevant findings by each structural neuroimaging technique. When validated across many studies, such findings can serve as neuroanatomic markers that can help generate rational hypotheses for future studies to further our understanding of geriatric depression. PMID:21536166

  13. Physiology Considerations in Geriatric Patients.

    PubMed

    Alvis, Bret D; Hughes, Christopher G

    2015-09-01

    Physiology changes at the structural, functional, and molecular levels as people age, and every major organ system experiences physiologic change with time. The changes to the nervous system result mostly in cognitive impairments, the cardiovascular system develops higher blood pressures with lower cardiac output, the respiratory system undergoes a reduction of arterial oxyhemoglobin levels, the gastrointestinal system experiences delayed gastric emptying and reduction of hepatic metabolism, and the renal system experiences a diminished glomerular filtration rate. Combined, these changes create a complex physiologic condition. This unique physiology must be taken into consideration for geriatric patients undergoing general anesthesia. PMID:26315630

  14. Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation.

    PubMed

    Barón-Esquivias, Gonzalo; Manito, Nicolás; López Díaz, Javier; Martín Santana, Antonio; García Pinilla, José Manuel; Gómez Doblas, Juan José; Gómez Bueno, Manuel; Barrios Alonso, Vivencio; Lambert, José Luis

    2015-04-01

    In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices.

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  16. Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium.

    PubMed

    Van de Velde, A L; Beutels, P; Smits, E L; Van Tendeloo, V F; Nijs, G; Anguille, S; Verlinden, A; Gadisseur, A P; Schroyens, W A; Dom, S; Cornille, I; Goossens, H; Berneman, Z N

    2016-07-01

    The advent of new cell-based immunotherapies for leukemia offers treatment possibilities for certain leukemia subgroups. The wider acceptability of these new technologies in clinical practice will depend on its impact on survival and costs. Due to the small patient groups who have received it, these aspects have remained understudied. This non-randomized single-center study evaluated medical costs and survival for acute myeloid leukemia between 2005 and 2010 in 50 patients: patients treated with induction and consolidation chemotherapy (ICT) alone; patients treated with ICT plus allogeneic hematopoietic stem cell transplantation (HCT), which is the current preferred post-remission therapy in patients with intermediate- and poor-risk AML with few co-morbidities, and patients treated with ICT plus immunotherapy using autologous dendritic cells (DC) engineered to express the Wilms' tumor protein (WT1). Total costs including post- consolidation costs on medical care at the hematology ward and outpatient clinic, pharmaceutical prescriptions, intensive care ward, laboratory tests and medical imaging were analyzed. Survival was markedly better in HCT and DC. HCT and DC were more costly than ICT. The median total costs for HCT and DC were similar. These results need to be confirmed to enable more thorough cost-effectiveness analyses, based on observations from multicenter, randomized clinical trials and preferably using quality-adjusted life-years as an outcome measure. PMID:27111858

  17. Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults.

    PubMed

    2014-05-01

    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.

  18. 'The time it takes…' How doctors spend their time admitting a patient during the acute medical take.

    PubMed

    Sabin, Jodie; Khan, Waleed; Subbe, Christian P; Franklin, Marc; Abulela, Iman; Khan, Anwar; Mohammed, Hassan

    2016-08-01

    Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. History taking and examination by a core medical trainee took 22 minutes for a patient referred from the ED and 21 minutes for a patient referred from primary care. A complete admission clerking with prescription and ordering of investigations ranged from a mean of 15 minutes for a consultant in acute medicine to a mean of 55 minutes for a foundation year 1 trainee. The duration of post-take ward rounds also showed significant variability.Our data can be used to model staffing patterns if combined with information about admission numbers and local set up.

  19. [THE ORGANIZATIONAL TECHNOLOGIES OF INCREASING QUALITY OF SPECIALIZED MEDICAL CARE UNDER ACUTE CORONARY SYNDROME AS EXEMPLIFIED BY THE KEMEROVSKAIA OBLAST].

    PubMed

    Kusch, O V; Artamonova, G V; Barbarash, L S

    2015-01-01

    The article considers means of development ofsystem of specialized medical care under acute coronary syndrome. The new organizational approaches provide optimization of structure of specialized hospital, development of mechanisms of multi-stage and multi-level interaction of medical organizations of the subject of the Russian Federation as exemplifed by the Kemerovskaia oblast and integration of resources of institutions of health care, science and education.

  20. Simulating Geriatric Home Safety Assessments in a Three-Dimensional Virtual World

    ERIC Educational Resources Information Center

    Andrade, Allen D.; Cifuentes, Pedro; Mintzer, Michael J.; Roos, Bernard A.; Anam, Ramanakumar; Ruiz, Jorge G.

    2012-01-01

    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…

  1. 76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... dementia and program advances in palliative care, and performance and oversight of the VA Geriatric... Committee assesses the capability of VA health care facilities and programs to meet the medical... and extended care programs, aging research activities, update on VA's employee staff working in...

  2. 78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research.... The Committee assesses the capability of VA health care facilities and programs to meet the medical... and extended care programs, aging research activities, updates on VA's employee staff working in...

  3. 77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-13

    ... dementia and program advances in palliative care, and performance and oversight of VA Geriatric Research.... The Committee assesses the capability of VA health care facilities and programs to meet the medical... and extended care programs, aging research activities, updates on VA's employee staff working in...

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

    PubMed

    Gogol, Manfred; Siebenhofer, Andrea

    2016-04-01

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

  5. An autonomy supportive model of geriatric team function.

    PubMed

    Powers, J S; White, S; Varnell, L; Turvy, C; Kidd, K; Harrell, D; Knight, B; Floyd, K; Zupko, K

    2000-08-01

    Interdisciplinary teams play a critical role in the delivery of geriatric health care. Health care professionals are commonly left to develop teamwork skills by chance. Medical team function differs from traditional group theory in that all members are caregivers. A non-competitive supportive atmosphere is appropriate for patient care. We propose a participatory (autonomy supportive) model fostering self-realization and positive reinforcement as an organizing philosophy. The primary group task is to maximize patient functional independence and personal goals. Leadership is task-dependent.

  6. Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

    PubMed Central

    Munro, Malcolm G

    2013-01-01

    Acute uterine bleeding unrelated to pregnancy has been defined as bleeding “sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention.” The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women. PMID:24355890

  7. Application of pattern recognition tools for classifying acute coronary syndrome: an integrated medical modeling

    PubMed Central

    2013-01-01

    Objective The classification of Acute Coronary Syndrome (ACS), using artificial intelligence (AI), has recently drawn the attention of the medical researchers. Using this approach, patients with myocardial infarction can be differentiated from those with unstable angina. The present study aims to develop an integrated model, based on the feature selection and classification, for the automatic classification of ACS. Methods A dataset containing medical records of 809 patients suspected to suffer from ACS was used. For each subject, 266 clinical factors were collected. At first, a feature selection was performed based on interviews with 20 cardiologists; thereby 40 seminal features for classifying ACS were selected. Next, a feature selection algorithm was also applied to detect a subset of the features with the best classification accuracy. As a result, the feature numbers considerably reduced to only seven. Lastly, based on the seven selected features, eight various common pattern recognition tools for classification of ACS were used. Results The performance of the aforementioned classifiers was compared based on their accuracy computed from their confusion matrices. Among these methods, the multi-layer perceptron showed the best performance with the 83.2% accuracy. Conclusion The results reveal that an integrated AI-based feature selection and classification approach is an effective method for the early and accurate classification of ACS and ultimately a timely diagnosis and treatment of this disease. PMID:24044669

  8. [The mobile geriatrics team, global patient management].

    PubMed

    Bach, Fréderiue; Bloch, Frédéric

    2013-01-01

    The mobile geriatric team of Cochin hospital in Paris is responsible for the management and orientation of fragile elderly patients over the age of 75 admitted to emergency departments. It carries out a multi-disciplinary assessment, contributes to the creation of the care project and life project of geriatric patients and is involved in organising the patient's return home. This article focuses on the role of the social assistant through two clinical cases.

  9. Geriatric rehabilitation and resilience from a cultural perspective.

    PubMed

    Yee-Melichar, Darlene; Boyle, Andrea Renwanz; Wanek, Linda J; Pawlowsky, Sarah B

    2014-01-01

    Resiliency is a key aspect to aging successfully. Promoting healthy lifestyles, strong social bonds, enhancements to one's environment, accessibility to quality care and rehabilitation are critical in a positive aging experience. Issues of personal, social, medical, and rehabilitative care are addressed in the context of resiliency from a cultural perspective. Various research studies explore resiliency through the progression of aging within changing environments, medical needs, and social conditions. Findings suggest that a strong connection to culture, accessibility to medical attention, and comprehensive assessment of a patient's background can effectively improve the rehabilitation for an aging individual. This article addresses aspects of caregiving that are essential in raising cultural sensitivity and resiliency, discussing three case studies (i.e. fall risk; stroke; congestive heart failure) in the geriatric patient. Resiliency in culture and rehabilitation has a connection needed to advance the quality of care and quality of life for an aging patient population.

  10. Early Medication Nonadherence After Acute Myocardial Infarction: Insights into Actionable Opportunities from the TRANSLATE-ACS Study

    PubMed Central

    Mathews, Robin; Peterson, Eric D.; Honeycutt, Emily; Chin, Chee Tang; Effron, Mark B.; Zettler, Marjorie; Fonarow, Gregg C.; Henry, Timothy D.; Wang, Tracy Y.

    2015-01-01

    Background Nonadherence to prescribed evidence-based medications after acute myocardial infarction (MI) can contribute to worse outcomes and higher costs. We sought to better understand the modifiable factors contributing to early nonadherence of evidence-based medications after acute MI. Methods and Results We assessed 7,425 acute MI patients treated with percutaneous coronary intervention (PCI) at 216 United States hospitals participating in TRANSLATE-ACS between 04/2010–05/2012. Using the validated Morisky instrument to assess cardiovascular medication adherence at 6 weeks post-MI, we stratified patients into self-reported high (score 8), moderate (score 6–7), and low (score <6) adherence groups. Moderate and low adherence was reported in 25% and 4% of patients, respectively. One-third of low adherence patients described missing doses of antiplatelet therapy at least twice a week after PCI. Signs of depression and patient-reported financial hardship due to medication expenses were independently associated with a higher likelihood of medication nonadherence. Patients were more likely to be adherent at 6 weeks if they had follow-up appointments made prior to discharge and had a provider explain potential side effects of their medications. Lower medication adherence may be associated with a higher risk of 3-month death/readmission (adjusted HR 1.35, 95% CI 0.98, 1.87) although this did not reach statistical significance. Conclusions Even early after MI, a substantial proportion of patients report suboptimal adherence to prescribed medications. Tailored patient education and pre-discharge planning may represent actionable opportunities to optimize patient adherence and clinical outcomes. Clinical Trial Registry Information clinical trial #NCT01088503; URL: https://clinicaltrials.gov/ct2/show/NCT01088503 PMID:26038524

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

    ERIC Educational Resources Information Center

    Kantor, Bonnie S.; Myers, Michelle R.

    2006-01-01

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

  12. [Despite medication, overdrive pacing is required to stabilize the electrical storm associated with acute coronary syndrome: a case report].

    PubMed

    Umeda, Masanobu; Morimoto, Atsushi; Yokoyama, Kaori; Tateishi, Emi; Makino, Kanako; Yamamoto, Kazuo; Nakagawa, Yoko; Fukuhara, Shinya; Takase, Eiji

    2007-10-01

    A 75-year-old female complained of severe chest pain and was emergently admitted to our hospital because of anterior acute myocardial infarction. Emergent coronary angiography was performed and revealed occlusion in segment 7, so a stent was implanted. Lidocaine, carvedilol, amiodarone, magnesium, and nifekalant were administered successively because non-sustained ventricular tachycardia (NSVT) frequently appeared like an electrical storm. After nifekalant administration, QTc was significantly prolonged and torsades de pointes was induced. Overdrive pacing was performed and finally the NSVT was completely controlled. If fatal arrhythmias such as NSVT show resistance to medication, overdrive pacing should be considered to stabilize the arrhythmia associated with acute coronary syndrome.

  13. Incontinence-associated dermatitis and pressure ulcers in geriatric patients.

    PubMed

    Kottner, J; Beeckman, D

    2015-12-01

    The key characteristics of geriatric patients are advanced age, multimorbidity, a decrease of psychical performance and care dependency. In addition, advanced age, chronic and acute diseases and treatments (e.g. polypharmacy) lead, either directly or indirectly, to a wide range of skin and tissue problems. Incontinence-associated dermatitis and pressure ulcers (PUs) belong to the most prevalent in geriatric settings. Prolonged exposure of the skin to urine and/or stool can cause an irritant contact dermatitis. Skin surface 'wetness', increased skin surface pH, digestive intestinal enzymes, repeated skin cleansing activities, and a possible occlusive environment contribute to irritation and inflammation. Prevention and treatment includes activities to maintain and to enhance continence and to limit, to reduce exposure of the skin to urine and stool, and to promote healing and reepithelialisation. In frail aged skin, it is recommended to use incontinence products with smooth and breathable materials with maximum absorption capacity. Immediate skin cleansing after soiling using mild cleansers and protective and caring leave-on products are recommended. PUs are localized injuries to the skin and/or underlying tissue caused by sustained deformations of skin and underlying soft tissues. PUs management includes risk assessment, repositioning and mobilization, and the use of appropriate support surfaces. Patients must be never positioned directly on an existing PU. Especially at end of life, the PU closure and wound healing may not be the primary therapeutic goal.

  14. Use of emergency medical services in the second gulf registry of acute coronary events.

    PubMed

    AlHabib, Khalid F; Alfaleh, Hussam; Hersi, Ahmad; Kashour, Tarek; Alsheikh-Ali, Alawi A; Suwaidi, Jassim Al; Sulaiman, Kadhim; Saif, Shukri Al; Almahmeed, Wael; Asaad, Nidal; Amin, Haitham; Al-Motarreb, Ahmed; Thalib, Lukman

    2014-09-01

    Data are scarce regarding emergency medical service (EMS) usage by patients with acute coronary syndrome (ACS) in the Arabian Gulf region. This 9-month in-hospital prospective ACS registry was conducted in Arabian Gulf countries, with 30-day and 1-year follow-up mortality rates. Of 5184 patients with ACS, 1293 (25%) arrived at the hospital by EMS. The EMS group (vs non-EMS) was more likely to be male, have cardiac arrest on presentation, be current or exsmokers, and have moderate or severe left ventricular dysfunction and ST-segment elevation myocardial infarction (STEMI). The EMS group had higher crude mortality rates during hospitalization and after hospital discharge but not after adjustment for clinical factors and treatments. The EMSs are underused in the Arabian Gulf region. Short- and long-term mortality rates in patients with ACS are similar between those who used and did not use EMS. Quality improvement in the EMS infrastructure and establishment of integrated STEMI networks are urgently needed. PMID:24019088

  15. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

    PubMed Central

    Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Objective Evaluate specific factors for development of delirium in a geriatric ward setting. Methods Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Results Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014). Conclusion Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting. PMID:27103793

  16. Diagnostic workup for weight loss in the geriatric horse.

    PubMed

    Dickinson, Charles E; Lori, David N

    2002-12-01

    In the absence of debilitating medical problems, the geriatric horse can maintain a normal body condition when provided with an appropriate diet, adequate shelter, and preventive health care that includes regular dental care and deworming. Failures in management can lead to inadequate nutritional support, exposure to adverse environmental conditions, advanced dental disease, parasitism, and failure to detect developing medical problems. All these circumstances can lead to loss of condition and debilitation in the aged horse. Weight loss in the aged horse should be approached with an understanding of the basic pathophysiologic mechanisms of weight loss and the factors that can predispose older horses to weight loss. As always, a thorough history and physical examination are critical in reaching a diagnosis.

  17. European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

    PubMed Central

    Baijens, Laura WJ; Clavé, Pere; Cras, Patrick; Ekberg, Olle; Forster, Alexandre; Kolb, Gerald F; Leners, Jean-Claude; Masiero, Stefano; Mateos-Nozal, Jesús; Ortega, Omar; Smithard, David G; Speyer, Renée; Walshe, Margaret

    2016-01-01

    This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies

  18. Chronic diseases in captive geriatric female Chimpanzees (Pan troglodytes).

    PubMed

    Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L

    2012-04-01

    The current aging population of captive chimpanzees is expected to develop age-related diseases and present new challenges to providing their veterinary care. Spontaneous heart disease and sudden cardiac death are the main causes of death in chimpanzees (especially of male animals), but little is known about the relative frequency of other chronic diseases. Furthermore, female chimpanzees appear to outlive the males and scant literature addresses clinical conditions that affect female chimpanzees. Here we characterize the types and prevalence of chronic disease seen in geriatric (older than 35 y) female chimpanzees in the colony at Alamogordo Primate Facility. Of the 16 female chimpanzees that fit the age category, 87.5% had some form of chronic age-related disease. Cardiovascular-related disease was the most common (81.25%) followed by metabolic syndrome (43.75%) and renal disease (31.25%). These data show the incidence of disease in geriatric female chimpanzees and predict likely medical management challenges associated with maintaining an aging chimpanzee population. PMID:22546920

  19. Chronic Diseases in Captive Geriatric Female Chimpanzees (Pan troglodytes)

    PubMed Central

    Nunamaker, Elizabeth A; Lee, D Rick; Lammey, Michael L

    2012-01-01

    The current aging population of captive chimpanzees is expected to develop age-related diseases and present new challenges to providing their veterinary care. Spontaneous heart disease and sudden cardiac death are the main causes of death in chimpanzees (especially of male animals), but little is known about the relative frequency of other chronic diseases. Furthermore, female chimpanzees appear to outlive the males and scant literature addresses clinical conditions that affect female chimpanzees. Here we characterize the types and prevalence of chronic disease seen in geriatric (older than 35 y) female chimpanzees in the colony at Alamogordo Primate Facility. Of the 16 female chimpanzees that fit the age category, 87.5% had some form of chronic age-related disease. Cardiovascular-related disease was the most common (81.25%) followed by metabolic syndrome (43.75%) and renal disease (31.25%). These data show the incidence of disease in geriatric female chimpanzees and predict likely medical management challenges associated with maintaining an aging chimpanzee population. PMID:22546920

  20. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    PubMed Central

    Ellis, Kristen; Rubal-Peace, Georgina; Chang, Victoria; Liang, Eva; Wong, Nicolas; Campbell, Stephanie

    2016-01-01

    Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit. PMID:27025523

  1. Antimicrobial Stewardship for a Geriatric Behavioral Health Population.

    PubMed

    Ellis, Kristen; Rubal-Peace, Georgina; Chang, Victoria; Liang, Eva; Wong, Nicolas; Campbell, Stephanie

    2016-01-01

    Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU). Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02), and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01). There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04). Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit.

  2. Palliative Care for the Geriatric Anesthesiologist.

    PubMed

    Gustin, Allen N; Aslakson, Rebecca A

    2015-09-01

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

  3. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

  4. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. PMID:25847647

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

    PubMed

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

    2009-09-01

    This article describes medical students' evaluation of a geriatric clerkship in postacute rehabilitative care settings. This was a cross-sectional study of fourth-year medical students who completed a mandatory 2-week rotation at a postacute care facility. Students were provided with three instructional methods: Web-based interactive learning modules; small-group sessions with geriatric faculty; and Geriatric Interdisciplinary Care Summary (GICS), a grid that students used to formulate comprehensive interdisciplinary care plans for their own patients. After the rotation, students evaluated the overall clerkship, patient care activities, and usefulness of the three instructional methods using a 5-point Likert scale (1=poor to 5=excellent) and listed their area of future specialty. Of 156 students who completed the rotation, 117 (75%) completed the evaluation. Thirty (26%) chose specialties providing chronic disease management such as family, internal medicine, and psychiatry; 34 (29%) chose specialties providing primarily procedural services such as surgery, radiology, anesthesiology, pathology, and radiation oncology. Students rated the usefulness of the GICS as good to very good (mean+/-standard deviation 3.3+/-1.0). Similarly, they rated overall clerkship as good to excellent (3.8+/-1.0). Analysis of variance revealed no significant group difference in any of the responses from students with the overall clerkship (F(112, 4)=1.7, P=.20). Students rated the geriatric clerkship favorably and found the multimodal instruction to be useful. Even for students whose career choice was not primary care, geriatrics was a good model for interdisciplinary care training and could serve as a model for other disciplines. PMID:19682134

  6. Pentoxifylline Treatment in Acute Pancreatitis (AP)

    ClinicalTrials.gov

    2016-09-14

    Acute Pancreatitis (AP); Gallstone Pancreatitis; Alcoholic Pancreatitis; Post-ERCP/Post-procedural Pancreatitis; Trauma Acute Pancreatitis; Hypertriglyceridemia Acute Pancreatitis; Idiopathic (Unknown) Acute Pancreatitis; Medication Induced Acute Pancreatitis; Cancer Acute Pancreatitis; Miscellaneous (i.e. Acute on Chronic Pancreatitis)

  7. Addressing ethical issues in geriatrics and long-term care: ethics education at the Baycrest Centre for Geriatric Care.

    PubMed

    Gordon, M; Turner, L; Bourret, E

    2000-01-01

    An innovative program in ethics education exists at Baycrest Centre for Geriatric Care. This program can serve as a helpful model for long-term care and geriatric care facilities seeking to implement formal training programs in bioethics. Various aspects of the ethics education program are examined. In addition to describing the role of the ethics committee and research ethics board, consideration is given to case consultations, ethics rounds, the training of junior physicians and medical students, grand rounds and the planning of conferences and guest lectures. With regard to educational content in bioethics, health law, professional guidelines and the principlist approach of Beauchamp and Childress are used to explore the ethical dimensions of particular cases. Given the clinical context of the educational initiatives, the pedagogical approach is predominately case-based. While the bioethics literature emphasizes the patient-physician relationship, ethics education at Baycrest recognizes the importance of multiple professions. Physicians, nurses, social workers, speech pathologists, nutritionists and other health care providers are involved in ethical deliberation and education. PMID:11143884

  8. Lack of association of acute phase response proteins with hormone levels and antidepressant medication in perimenopausal depression

    PubMed Central

    2014-01-01

    Background Major depression is associated with higher plasma levels of positive acute-phase proteins, as well as with lower plasma levels of negative acute-phase proteins. The aim of this study is to examine the levels of acute-phase response proteins and whether these levels are influenced by reproductive hormones and antidepressant medication in the perimenopausal depression. Methods Sixty-five women (age range: 40–58 years old) participated in this study. All women were in the perimenopausal phase. The diagnosis of depression was made through a psychiatric interview and with the aid of Hamilton Depression Rating Scale 17 (HAM-D 17). The acute-phase response proteins, such as haptoglobin (HP), transferrine (TRf), α1-antitrypsin, complement protein 3 (C3), complement protein 4 (C4) and C-reactive protein (CRP) and the reproductive hormones, for example follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), were analyzed using standard laboratory methods. Pearson’s correlations were applied to evaluate the relationship between acute-phase proteins and hormones. Results Perimenopausal women were divided into three groups. The first group consisted of normal controls, the second one involved depressed perimenopausal women, who were taking selective serotonin reuptake inhibitors (SSRIs), and the third one included depressed women that were not treated with SSRIs. Depressed women in perimenopause, when being compared to non-depressed women, did not differ as to serum levels of acute-phase proteins. There was a positive correlation between HP and E2 in depressed perimenopausal women, who were not taking SSRIs. Conclusions The lack of association between acute-phase proteins and depressive mood mentioned in this study does not support previous findings in patients with major depression. This negative finding in perimenopausal depression indicates either the absence or a more complex nature of the interactions between acute-phase proteins

  9. 21 CFR 880.6140 - Medical chair and table.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Devices § 880.6140 Medical chair and table. (a) Identification. A medical chair or table is a device... donors, geriatric patients, or patients undergoing treatment or examination. (b) Classification. Class...

  10. Management of diabetes mellitus type-2 in the geriatric population: Current perspectives.

    PubMed

    Bajwa, Sukhminder Jit Singh; Sehgal, Vishal; Kalra, Sanjay; Baruah, Manash Pratim

    2014-07-01

    The prevalence of diabetes mellitus (DM) has increased exponentially throughout the world and there is rapid increase in elderly diabetics. DM is associated with increased mortality and considerable morbidity including stroke, heart disease, and diminished quality of life in the elderly. However, the unique features of geriatric diabetes have not been given due a prominence in medical literature. Hypoglycemia remains the biggest complicating factor and needs to be avoided in the elderly. Most people in the geriatric age group have some degree of renal insufficiency and medications need to be adjusted wisely with changing renal profile. Because safer and more effective pharmacological therapy is available, an individual approach to DM in the elderly is essential.

  11. Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes

    PubMed Central

    Nakajima, Yoshie; Ogawa, Tomohiro; Mo, Makoto; Tazaki, Junichi; Doi, Takahiro; Yamada, Norikazu; Suzuki, Takeo; Nakajima, Hiromu

    2016-01-01

    Objective: To investigate the usefulness of D-dimer as a screening method as well as to explore potent predictors of deep vein thrombosis (DVT) in hospitalized Japanese patients with acute medical diseases/episodes. Methods and Subjects: This study was a multi-center, prospective, observational study. The inclusion criteria were hospitalized patients at high risk of developing venous thromboembolism with; (1) congestive heart failure, acute exacerbation of chronic obstructive pulmonary disease, infectious diseases, or inflammatory diseases, (2) bed rest ≥4 days, and (3) ≥60 years old. D-dimer was measured on the same day as ultrasonography. Multivariate logistic regression analysis was performed to investigate predictors associated with the presence of DVT. Results: Sixty-nine patients were enrolled. The prevalence of DVT was 33.3% (23/69; 95% C.I., 19.4% to 47.3%). D-dimer was measured in 42 patients and the sensitivity and negative predictive value reached 100%, while the specificity (13.3%) and positive predictive value (31.6%) were low (cut-off value: 0.9 or 1.0 µg/mL). Statistically significant predictor was not assigned. Conclusion: As the sensitivity and negative predictive value of D-dimer reached 100%, D-dimer have a role in excluding patients who might otherwise undergo diagnostic imaging for DVT in hospitalized Japanese patients with acute medical diseases/episodes. PMID:27738461

  12. An Enduring Somatic Threat Model of Posttraumatic Stress Disorder Due to Acute Life-Threatening Medical Events

    PubMed Central

    Edmondson, Donald

    2014-01-01

    Posttraumatic stress disorder (PTSD) occurs in 12-25% of survivors of acute life-threatening medical events such as heart attack, stroke, and cancer, and is associated with recurrence of cardiac events and mortality in heart attack survivors. This article reviews the current state of knowledge about PTSD after such events, and proposes an Enduring Somatic Threat (EST) model of PTSD due to acute life-threatening medical events to address underappreciated differences between PTSD due to past, discrete/external traumatic events (such as combat) and PTSD due to acute manifestations of chronic disease that are enduring/internal in nature (such as heart attack and stroke). The differences include the external versus internal/somatic source of the threat, the past versus present/future temporal focus of threatening cognitions, the different types and consequences of avoidance behavior, and the different character and consequences of hyperarousal. Although important differences between the two types of PTSD exist, the EST model proposes that the underlying fear of mortality maintains PTSD symptoms due to both discrete/external and ongoing/somatic events. Finally, this article offers a research agenda for testing the EST model, with a particular focus on areas that may improve cardiovascular prognosis and health behaviors in survivors of heart attack and stroke. PMID:24920956

  13. Faculty Preparedness in Geriatric Optometry Education.

    ERIC Educational Resources Information Center

    Mancil, Gary L.; And Others

    1995-01-01

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

  14. Distortion product otoacoustic emissions in geriatric dogs.

    PubMed

    Strain, G M; Rosado Martinez, A J; McGee, K A; McMillan, C L

    2016-10-01

    Recordings of distortion product otoacoustic emissions (DPOAE) were taken from 28 geriatric dogs aged 12.2 ± 2.2 years and 15 control dogs aged 5.9 ± 3.0 years (mean ± standard deviation) to demonstrate frequency-specific changes in cochlear responses. Recordings were performed for primary frequencies of 2-12 kHz in 2 kHz increments. Brainstem auditory evoked response (BAER) recordings were also made from geriatric dogs for comparison with DPOAE responses. Significant decreases in DPOAE response amplitudes were observed at frequencies of 6-12 kHz in geriatric dogs compared to control dogs, reflecting loss of cochlear outer hair cells along the length of the cochlea. Significant decreases in response amplitudes were not seen at frequencies of 2 or 4 kHz. Decreases in BAER response amplitudes subjectively paralleled the depressed DPOAE amplitudes. No significant linear regression relationships were found for DPOAE response amplitude vs. age despite the progressive nature of age-related hearing loss. The reductions in response at all frequencies starting at the age where dogs are considered geriatric indicate that age-related hearing loss begins earlier in the life span. DPOAE recordings provide a means to assess cochlear function across different portions of the auditory spectrum for assessing hearing loss associated with aging, and potentially for losses from other causes of decreased auditory function.

  15. Distortion product otoacoustic emissions in geriatric dogs.

    PubMed

    Strain, G M; Rosado Martinez, A J; McGee, K A; McMillan, C L

    2016-10-01

    Recordings of distortion product otoacoustic emissions (DPOAE) were taken from 28 geriatric dogs aged 12.2 ± 2.2 years and 15 control dogs aged 5.9 ± 3.0 years (mean ± standard deviation) to demonstrate frequency-specific changes in cochlear responses. Recordings were performed for primary frequencies of 2-12 kHz in 2 kHz increments. Brainstem auditory evoked response (BAER) recordings were also made from geriatric dogs for comparison with DPOAE responses. Significant decreases in DPOAE response amplitudes were observed at frequencies of 6-12 kHz in geriatric dogs compared to control dogs, reflecting loss of cochlear outer hair cells along the length of the cochlea. Significant decreases in response amplitudes were not seen at frequencies of 2 or 4 kHz. Decreases in BAER response amplitudes subjectively paralleled the depressed DPOAE amplitudes. No significant linear regression relationships were found for DPOAE response amplitude vs. age despite the progressive nature of age-related hearing loss. The reductions in response at all frequencies starting at the age where dogs are considered geriatric indicate that age-related hearing loss begins earlier in the life span. DPOAE recordings provide a means to assess cochlear function across different portions of the auditory spectrum for assessing hearing loss associated with aging, and potentially for losses from other causes of decreased auditory function. PMID:27687934

  16. Training Internal Medicine Residents in Geriatrics.

    ERIC Educational Resources Information Center

    Wolf-Klein, Gisele P.; And Others

    1983-01-01

    A four-week geriatric rotation in a nursing home that emphasized rehabilitation for stroke victims, patients with fractured hips, and amputees, and the team approach in care for the elderly is described. Student response was very positive, student sensitivity was improved, and all students felt the team approach could be applied to later practice.…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

    This paper describes development, implementation, and evaluation strategies of a longitudinal geriatric curriculum, the Senior Mentor Program (SMP). The rationale for exposing undergraduate medical students to healthy, community-dwelling older adults is to use the relationship and activities as vehicles for improving knowledge of aging and…

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

    ERIC Educational Resources Information Center

    Bornat, Joanna; Henry, Leroi; Raghuram, Parvati

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Del Duca, Danny; Duque, Gustavo

    2006-01-01

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

  20. Redesigning geriatric healthcare: how cross-functional teams and process improvement provide a competitive advantage.

    PubMed

    Andrews, B C; Kaye, J; Bowcutt, M; Campbell, J

    2001-01-01

    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 rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.

  1. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study.

    PubMed

    Cohen, Alexander T; Harrington, Robert; Goldhaber, Samuel Z; Hull, Russell; Gibson, C Michael; Hernandez, Adrian F; Kitt, Michael M; Lorenz, Todd J

    2014-03-01

    Randomized clinical trials have identified a population of acute medically ill patients who remain at risk for venous thromboembolism (VTE) beyond the standard duration of therapy and hospital discharge. The aim of the APEX study is to determine whether extended administration of oral betrixaban (35-42 days) is superior to a standard short course of prophylaxis with subcutaneous enoxaparin (10 ± 4 days followed by placebo) in patients with known risk factors for post-discharge VTE. Patients initially are randomized to receive either betrixaban or enoxaparin (and matching placebo) in a double dummy design. Following a standard duration period of enoxaparin treatment (with placebo tablets) or betrixaban (with placebo injections), patients receive only betrixaban (or alternative matching placebo). Patients are considered for enrollment if they are older than 40 years, have a specified medical illness, and restricted mobility. They must also meet the APEX criteria for increased VTE risk (aged ≥75 years, baseline D-Dimer ≥2× upper the limit of "normal", or 2 additional ancillary risk factors for VTE). The primary efficacy end point is the composite of asymptomatic proximal deep venous thrombosis, symptomatic deep venous thrombosis, non-fatal (pulmonary embolus) pulmonary embolism, or VTE-related death through day 35. The primary safety outcome is the occurrence of major bleeding. We hypothesize that extended duration betrixaban VTE prophylaxis will be safe and more effective than standard short duration enoxaparin in preventing VTE in acute medically ill patients with known risk factors for post hospital discharge VTE. PMID:24576517

  2. Xerostomia in the Geriatric Patient: Causes, Oral Manifestations, and Treatment.

    PubMed

    Ouanounou, Aviv

    2016-05-01

    Xerostomia, or dry mouth, is common among elderly people and is typically associated with decreased salivary gland function. Causes of xerostomia in the geriatric population have been attributed to the use of medications, chronic disorders, and radiation therapy to the head and neck region. Patients with chronic xerostomia may have multiple oral and dental consequences such as dental caries, periodontal disease, fungal infections, ill-fitting dentures, and taste alterations. Xerostomia can seriously impact quality of life and may alter speech, eating, and swallowing. Current therapeutics for the management of xerostomia are grouped as local and systemic salivary stimulation. This article reviews the main reasons for xerostomia and the complications it causes in the oral cavity. It also discusses the pharmacologic and nonpharmacologic agents used to treat this condition. PMID:27213776

  3. Ethical issues in end-of-life geriatric care: the approach of three monotheistic religions-Judaism, Catholicism, and Islam.

    PubMed

    Clarfield, A Mark; Gordon, Michael; Markwell, Hazel; Alibhai, Shabbir M H

    2003-08-01

    Ethical dilemmas pervade modern geriatric medicine. What is considered right or wrong will differ depending on, among other things, the patient's religion. The three Abrahamic monotheistic religions, Judaism, Christianity (its Catholic variant), and Islam all have carefully considered positions on medical ethics. Although much is held in common, there are significant differences. The authors present three clinical cases, each of which presents ethical dilemmas typical of geriatric care, especially at the end of life. On the basis of these scenarios, the normative ethical position of each religion is compared and contrasted. It is hoped that this approach will offer the geriatrician a useful approach to treating patients in an increasingly multicultural society.

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

    PubMed

    Federspiel C; Keipes M

    2014-01-01

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

  5. A safe electric medical bed for an acute inpatient behavioral health care setting.

    PubMed

    Wagner, John J; Ingram, Todd N

    2013-01-01

    The purpose of this article is to describe the process of developing a safe electric bed for a traditional acute care adult behavioral health inpatient unit. Many articles and studies exist related to creating a safe environment on acute care psychiatric units, but very few address the use of electric hospital beds. The process of adapting a traditional electric bed for inpatient use by the nursing management team of the Behavioral Health Service at the University of Iowa Hospitals and Clinics is described, including specific safety features in the prototype bed. Policy changes during implementation and safety data after 12 months of bed use on the units are also presented. Results indicate that traditional electric hospital beds can be safely adapted for use on traditional acute care psychiatric units.

  6. Combining quality improvement and geriatrics training: the nursing home polypharmacy outcomes project.

    PubMed

    Kojima, Gotaro; Bell, Christina L; Tamura, Bruce; Davis, James; Inaba, Michiko; Lorenzo, Pia; Blanchette, Patricia Lanoie; Iwasaki, Wendy; Masaki, Kamal

    2014-01-01

    To examine sustained effects of an educational intervention, the authors repeated a successful quality improvement (QI) project on medication safety and cost effectiveness. In October 2007 and August 2008, the facility leadership and geriatrics faculty identified all patients receiving nine or more medications (polypharmacy cohort) in a 170-bed teaching nursing home. They then taught Geriatric Medicine fellows (n = 12 in 2007, 11 in 2008) to (a) systematically collect medication data; (b) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers criteria) or drug-drug interaction programs; (c) discuss recommendations with patients' attending physicians; and (d) implement approved recommendations. Over the two projects, the polypharmacy cohorts demonstrated decreased potentially inappropriate medications (odds ratio [OR] = .78, 95% confidence interval [95% CI] [0.69, 0.88], p < .001), contraindicated medications (OR = .63, 95% CI [0.47, 0.85], p = .002) and medication costs (OR = .97, 95% CI [0.96, 0.99], p < .001). Findings suggest that programs planning educational QI projects for trainees may benefit from a multiyear approach to maximize clinical and educational benefits. PMID:24829040

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

    ERIC Educational Resources Information Center

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

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

  8. Evaluating the Safety and Efficacy of Sodium-Restricted/Dietary Approaches to Stop Hypertension Diet After Acute Decompensated Heart Failure Hospitalization: Design and Rationale for the Geriatric OUt of hospital Randomized MEal Trial in Heart Failure (GOURMET-HF)

    PubMed Central

    Wessler, Jeffrey D.; Maurer, Mathew S.; Hummel, Scott S.

    2015-01-01

    Background Heart Failure (HF) is a major public health problem affecting predominantly older adults. Non-adherence to diet remains a significant contributor to acute decompensated HF (ADHF). The sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD) eating plan reduces cardiovascular dysfunction that can lead to ADHF and is consistent with current HF guidelines. We propose that an intervention that promotes adherence to the DASH/SRD by home-delivering meals will be safe and improve health-related quality of life (QOL) in older adults following hospitalization for ADHF. Methods/Design This is a three center, randomized, single-blind, controlled trial of 12 weeks duration designed to determine the safety and efficacy of home-delivered DASH/SRD-compliant meals in older adults following discharge from ADHF hospitalization. 66 subjects will be randomized in a 1:1 stratified fashion by gender and left ventricular ejection fraction (< vs. ≥50%). Study subjects will receive either pre-prepared, home-delivered DASH/SRD-compliant meals or usual dietary advice for 4 weeks after hospital discharge. Investigators will be blinded to group assignment, food diaries, and urinary electrolyte measurements until study completion. The primary efficacy endpoint is the change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) summary scores for health-related QOL from study enrollment to 4 weeks post-discharge. Safety evaluation will focus on hypotension, renal insufficiency, and hyperkalemia. Exploratory endpoints include echocardiography, non-invasive vascular testing, markers of oxidative stress, and salt taste sensitivity. Conclusion This randomized controlled trial will test the efficacy, feasibility and safety of 4 weeks of DASH/SRD after ADHF hospitalization. By testing a novel dietary intervention supported by multiple levels of evidence including preliminary data in outpatients with stable HF, we will address a critical evidence gap in the care of older

  9. Psychosocial determinants of burnout in geriatric nursing.

    PubMed

    Duquette, A; Kérouac, S; Sandhu, B K; Ducharme, F; Saulnier, P

    1995-10-01

    The purpose of this study was to identify determinants of burnout using an adapted version of Kobasa's theoretical framework, considering work stressors, work support, coping strategies and hardiness. Data were collected through a questionnaire mailed to 1990 randomly selected geriatric nurses. A participation rate of 77.6% was achieved. T-test, variance analysis and multiple regression analysis were conducted. Hierarchical multiple regression analysis indicated that 49% of the variance was explained by the study variables. Hardiness and work stressors were the most important predictors of burnout. The findings are discussed in relation to Kobasa's framework, focusing on resources that reduce negative effects of geriatric work stressors. Implications for nursing practice, management, education and research are proposed.

  10. Using Facebook Within a Geriatric Pharmacotherapy Course

    PubMed Central

    2010-01-01

    Objective To evaluate using an Internet-based social networking site within an elective geriatric pharmacotherapy course. Design Thirty pharmacy students enrolled in a geriatric pharmacotherapy elective course were invited to join a closed Facebook (Facebook Inc, Palo Alto, CA) group to enhance communication among students and faculty members within the course. Creating a discussion board was the primary activity in the course. Each week, 3 students were assigned to post a healthy aging topic, and other students in the class were expected to post their comments and reactions. The healthy aging topics also were discussed during class. Assessment Students wrote reflections about their experiences using Facebook for the activities within this course. A survey instrument also measured students' opinions about using Facebook for educational purposes. Conclusion Using Facebook allowed students to discuss topics more openly and encouraged classroom discussions of healthy aging topics. PMID:21179256

  11. Predictors for Delayed Emergency Department Care in Medical Patients with Acute Infections – An International Prospective Observational Study

    PubMed Central

    Hausfater, Pierre; Amin, Devendra; Amin, Adina; Haubitz, Sebastian; Conca, Antoinette; Reutlinger, Barbara; Canavaggio, Pauline; Sauvin, Gabrielle; Bernard, Maguy; Huber, Andreas; Mueller, Beat; Schuetz, Philipp

    2016-01-01

    Introduction In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections. Methods We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US). We studied predictors for delays in starting antibiotic treatment by using multivariate regression analyses. Results Overall, 544 medical ED patients with a main diagnosis of acute infection and antibiotic treatment were included, mainly pneumonia (n = 218; 40.1%), urinary tract (n = 141; 25.9%), and gastrointestinal infections (n = 58; 10.7%). The overall median time to start antibiotic therapy was 214 minutes (95% CI: 199, 228), with a median length of ED stay (ED LOS) of 322 minutes (95% CI: 308, 335). We found large variations of time to start antibiotic treatment depending on hospital centre and type of infection. The diagnosis of a gastrointestinal infection was the most significant predictor for delay in antibiotic treatment (+119 minutes compared to patients with pneumonia; 95% CI: 58, 181; p<0.001). Conclusions We found high variations in hospital ED performance in regard to start antibiotic treatment. The implementation of measures to reduce treatment times has the potential to improve patient care. PMID:27171476

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

    PubMed

    Petrovic, Mirko; Somers, Annemie; Onder, Graziano

    2016-03-01

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

  13. [Medical therapy for intracranial hemorrhage: update blood pressure management for prevention and acute treatment].

    PubMed

    Koga, Masatoshi; Toyoda, Kazunori

    2012-01-01

    Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). The guideline for the management of hypertension (JSH2009) recommends BP control of ≤ 140/90 mm Hg for patients with prior stroke. BP is frequently elevated in acute ICH, although BP management strategy is controversial. The guideline from the American Stroke Association suggests if systolic BP (SBP) >180 mm Hg and there is no evidence of elevated intracranial pressure, then consider a modest reduction of BP. A nationwide survey revealed that SBP lowering to ≤ 160 mm Hg using intravenous nicardipine in acute ICH is a major strategy in Japan, and the safety was confirmed by a multicenter, prospective, observational study. Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140 mm Hg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180 mm Hg) and strict control (<140 mm Hg). We have just started to enroll patients to ATACH II from Japan on February 2012.

  14. Geriatric nephrology: responding to a growing challenge.

    PubMed

    Rosner, Mitchell; Abdel-Rahman, Emaad; Williams, Mark E

    2010-05-01

    Changing demographics of the global population predict that the number of people age 65 years or greater will triple over the coming decades. Because the incidence and prevalence of kidney disease increase with advancing age, nephrologists will be increasingly confronted with a population of patients who are elderly and have a large number of comorbid conditions requiring ongoing care. Furthermore, it is increasingly understood that aging leads to its own unique aspects of nephrologic diagnosis and treatment. Although it is known that elderly patients constitute a group with special needs and present unique challenges to the nephrologist, traditional nephrology fellowship training has not included a focus on the geriatric population. In response to this need for greater education and awareness, the American Society of Nephrology has initiated a program of educational activities in geriatric nephrology and has chartered a specific advisory council. The priority being given to geriatric nephrology is a hopeful sign that issues such as treatment options, the efficacy of treatments, and their effect on quality of life for the elderly patient with kidney disease will be improved in the coming years.

  15. [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].

    PubMed

    Luger, Thomas J; Luger, Markus F

    2016-04-01

    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient. PMID:27090913

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

    PubMed

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

    2016-08-01

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

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

    PubMed Central

    Hogan, David B.

    2011-01-01

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

  18. A COMPREHENSIVE FRACTURE PREVENTION STRATEGY IN OLDER ADULTS: THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS) STATEMENT

    PubMed Central

    BLAIN, H.; MASUD, T.; DARGENT-MOLINA, P.; MARTIN, F.C.; ROSENDAHL, E.; VAN DER VELDE, N.; BOUSQUET, J.; BENETOS, A.; COOPER, C.; KANIS, J.A.; REGINSTER, J.Y.; RIZZOLI, R.; CORTET, B.; BARBAGALLO, M.; DREINHÖFER, K.E.; VELLAS, B.; MAGGI, S.; STRANDBERG, T.

    2016-01-01

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

  19. Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

    PubMed Central

    Zhao, Xingquan; Liao, Xiaoling; Wang, Chunjuan; Pan, Yuesong; Wang, Yilong; Wang, Yongjun

    2016-01-01

    Objective Increased blood pressure (BP) management following acute ischemic stroke (AIS) remains controversial. This study aimed to identify the association between BP and clinical outcomes in AIS patients administered lytic medication in the TIMS-China (thrombolysis implementation and monitor of acute ischemic stroke in China) database. Methods The sample comprised 1128 patients hospitalized within 4.5 hours (h) of AIS for intravenous recombinant tissue plasminogen activator (i.v. rt-PA) thrombolysis. Systolic BP (SBP) and diastolic BP (DBP) at baseline, 2 h and 24 h after treatment, and changes from baseline were analyzed. The study outcomes comprised a favorable outcome (modified Rankin Scale 0–1 at 90 days) and symptomatic intracerebral hemorrhage (SICH), analyzed using logistic regression, with low BP as the reference group. Results Lower BP (baseline, 2 h, and 24 h) was beneficial in AIS patients and significantly related to a favorable outcome (P<0.05). A substantial BP decrease at 24 h after rt-PA thrombolysis was significantly associated with a favorable outcome compared with a moderate BP decrease (P = 0.0298). A SBP >160 mmHg 2 h after rt-PA thrombolysis was significantly associated with SICH compared with a SBP <140 mmHg (P = 0.0238). An increase or no change (>25 mmHg) in SBP was significantly associated with SICH (P = 0.002) compared with a small SBP decrease (1–9 mmHg). Conclusions This study provides novel evidence that lower BP within the first 24 h is associated with a more favorable outcome and less frequent SICH in AIS patients administered lytic medication. Routine BP-lowering treatment should be considered in AIS patients following lytic medication. PMID:26828609

  20. Development and dissemination of Web-based clinical simulations for continuing geriatric nursing education.

    PubMed

    Kowlowitz, Vicki; Davenport, Carolyn S; Palmer, Mary H

    2009-04-01

    This article describes the process of developing and disseminating a Web-based library of geriatric clinical simulations used in continuing education workshops. Twenty-six peer-reviewed clinical simulations were developed on topics reflecting prevalent acute illnesses, conditions, or sentinel events that, if left undetected or untreated, could cause further comorbidity, hospitalization, or death. Geriatric nursing competencies identified by The John A. Hartford Foundation Institute for Geriatric Nursing were also incorporated. More than 700 workshop attendees and others have used these online clinical simulations. User evaluations of realism, accuracy of the situation or problem portrayed, and relevance to practice were rated as excellent or very good by more than 85% of the users. The University of North Carolina at Chapel Hill Center for Lifelong Learning Web site will offer this library with associated American Nurses Credentialing Center contact hours. This online access provides nurses high-quality continuing education offerings to increase knowledge and improve competence in the care of aging adults.

  1. Clinical features associated with medically unexplained stroke-like symptoms presenting to an acute stroke unit.

    PubMed

    Nazir, F S; Lees, K R; Bone, I

    2005-02-01

    In many areas of secondary care, symptoms unexplained by disease account for around one-third of all patients seen. We sought to investigate patients presenting with medically unexplained stroke-like symptoms to identify distinguishing features which may help to identify a non-organic aetiology. Patients given a discharge diagnosis of medically unexplained stroke-like symptoms over the preceding 11 years were identified retrospectively from a prospectively completed stroke unit database. Age- and sex-matched controls with ischaemic or haemorrhagic stroke or transient ischaemic attack were also identified. Clinical features on presentation, ischaemic risk factors, alcohol history, marital status and history of depression or anxiety were examined. Previous or subsequent admissions with medically unexplained syndromes were also examined via record linkage with hospital discharge records. A medically unexplained syndrome was assumed to be present if an International Classification of Diseases 9 discharge code for one or more of the thirteen conditions forming recognized functional syndromes was given. Logistic regression was applied to determine predictors of non-organicity. One hundred and five patients and controls, 1.6% of all stroke unit admissions were identified, 62% (65 patients) were females. Mean age was 50.3 +/- 14.9. Compared with age- and sex-matched controls patients with medically unexplained stroke-like symptoms were significantly more probable to have a headache at presentation (47% vs. 26%, P = 0.0004), have a diagnosis of one or more additional medically unexplained syndromes (24% vs. 11%, P = 0.007) but significantly less probable to present with symptoms of vertebrobasilar dysfunction (32% vs. 61%, P < 0.0001). A history of anxiety or depression, as recorded in the notes, was not found to be associated with a medically unexplained presentation. Medically unexplained stroke-like presentations are common (1.6% of all stroke presentations), they are

  2. Direct Medical Cost of Influenza-Related Hospitalizations among Severe Acute Respiratory Infections Cases in Three Provinces in China

    PubMed Central

    Zhu, Xiaoping; Gao, Lidong; Li, Zhong; Feng, Ao; Jin, Hui; Wang, Shiyuan; Su, Qiru; Xu, Zhen; Feng, Zijian

    2013-01-01

    Background Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. Methods Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI) sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital’s Hospital Information System (HIS) and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range) and median (interquartile range [IQR]) costs were calculated and compared among children (≤15 years), adults (16–64 years) and elderly (≥65 years) groups. Factors influencing cost were analyzed. Results A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range) direct medical cost was $1,797 ($80–$27,545) for all hospitalizations, and the median (IQR) direct medical cost was $231 ($164), $854 ($890), and $2,263 ($7,803) for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. Conclusion Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies. PMID:23717485

  3. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries.

    PubMed

    Ceppi, Francesco; Antillon, Federico; Pacheco, Carlos; Sullivan, Courtney E; Lam, Catherine G; Howard, Scott C; Conter, Valentino

    2015-10-01

    In the last two decades, remarkable progress in the treatment of children with acute lymphoblastic leukemia has been achieved in many low- and middle-income countries (LMIC), but survival rates remain significantly lower than those in high-income countries. Inadequate supportive care and consequent excess mortality from toxicity are important causes of treatment failure for children with acute lymphoblastic leukemia in LMIC. This article summarizes practical supportive care recommendations for healthcare providers practicing in LMIC, starting with core approaches in oncology nursing care, management of tumor lysis syndrome and mediastinal masses, nutritional support, use of blood products for anemia and thrombocytopenia, and palliative care. Prevention and treatment of infectious diseases are described in a parallel paper. PMID:26013005

  4. Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis.

    PubMed

    Sullivan, Matthew P; Baldwin, Keith D; Donegan, Derek J; Mehta, Samir; Ahn, Jaimo

    2014-03-01

    Geriatric acetabular, pelvis, and subtrochanteric femur fractures are poorly understood and rapidly growing clinical problems. The purpose of this study was to describe the epidemiologic trends of these injuries as compared with traditional fragility fractures about the hip. From 1993 to 2010, the Nationwide Inpatient Sample (NIS) recorded more than 600 million Medicare-paid hospital discharges. This retrospective study used the NIS to compare patients with acetabular fractures (n=87,771), pelvic fractures (n=522,831), and subtrochanteric fractures (n=170,872) with patients with traditional hip fractures (intertrochanteric and femoral neck, n=3,495,742) with regard to annual trends over an 18-year period in incidence, length of hospital stay, hospital mortality, transfers from acute care institutions, and hospital charges. Traditional hip fractures peaked in 1996 and declined by 25.7% by 2010. During the same 18-year period, geriatric acetabular fractures increased by 67%, subtrochanteric femur fractures increased by 42%, and pelvic fractures increased by 24%. Hospital charges, when controlling for inflation, increased roughly 50% for all fracture types. Furthermore, transfers from outside acute care hospitals for definitive management stayed elevated for acetabular fractures as compared with traditional hip fractures, suggesting a greater need for tertiary care of acetabular fractures. Geriatric acetabular fractures are rapidly increasing, whereas traditional hip fractures continue to decline. Patients with these injuries are more likely to be transferred from their hospital of presentation to another acute care institution, possibly increasing costs and complications. This is likely related to their complexity and the lack of consensus regarding optimal management.

  5. Acute renal failure secondary to ingestion of alternative medication in a patient with breast cancer.

    PubMed

    Gulia, S; Gota, V; Kumar, Sangita D; Gupta, Sudeep

    2015-01-01

    Complementary and alternative medicine (CAM) use among cancer patients is widely prevalent and often underreported. Advanced stage of disease is significantly associated with CAM use. The concurrent use of alternative medicines and chemotherapy drugs has the potential to lead to toxicities as well as altered therapeutic activity due to unknown interactions. We report a case of early breast cancer who presented to us with non-oliguric acute renal failure related concurrent use of Ayurvedic medicines and adjuvant anthracycline based.

  6. Acute thyroid eye disease (TED): principles of medical and surgical management.

    PubMed

    Verity, D H; Rose, G E

    2013-03-01

    The active inflammatory phase of thyroid eye disease (TED) is mediated by the innate immune system, and management is aimed at aborting this self-limited period of autoimmune activity. In most patients with TED, ocular and adnexal changes are mild and management involves controlling thyroid dysfunction, cessation of smoking, and addressing ocular surface inflammation and exposure. In patients with acute moderate disease, this being sufficient to impair orbital functions, immunosuppression reduces the long-term sequelae of acute inflammation, and adjunctive fractionated low-dose orbital radiotherapy is used as a steroid-sparing measure. Elective surgery is often required following moderate TED, be it for proptosis, diplopia, lid retraction, or to debulk the eyelid, and this should be delayed until the disease is quiescent, with the patient stable and weaned off all immunosuppression. Thus, surgical intervention during the active phase of moderate disease is rarely indicated, although clinical experience suggests that, where there is significant orbital congestion, early orbital decompression can limit progression to more severe disease. Acute severe TED poses a major risk of irreversible loss of vision due to marked exposure keratopathy, 'hydraulic' orbital congestion, or compressive optic neuropathy. If performed promptly, retractor recession with or without a suture tarsorrhaphy protects the ocular surface from severe exposure and, in patients not responding to high-dose corticosteroid treatment, decompression of the deep medial orbital wall and floor can rapidly relieve compressive optic neuropathy, as well as alleviate the inflammatory and congestive features of raised orbital pressure.

  7. Emotional dysfunction in a geriatric population: staff observations and patients' reports.

    PubMed

    Guilmette, T J; Snow, M G; Grace, J; Giuliano, A J

    1992-06-01

    This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial

    PubMed Central

    Haas, Mitchell; Glick, Ronald; Stevans, Joel; Landsittel, Doug

    2014-01-01

    Study Design Randomized-controlled trial with follow-up to 6 months. Objective This was a comparative effectiveness trial of: manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC). Summary of Background Data Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and sub-acute LBP, as compared to UMC. Methods 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM; MAM; or UMC. Outcome measures included the Oswestry LBP disability index (0 to 100 scale) and numeric pain rating (0 to 10 scale). Participants in the manipulation groups were treated twice weekly over 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months and 6 months. Results Linear regression showed a statistically significant advantage of MTM at 4 weeks compared to MAM (disability = −8.1, p = .009; pain = −1.4, p = .002) and UMC (disability = −6.5, p = .032; pain = −1.7, p < .001). Responder analysis, defined as 30% and 50% reductions in Oswestry scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared to MAM (50%; 16%) and UMC (48%; 39%).Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months. Conclusions MTM provides greater short-term reductions in self-reported disability and pain scores compared to UMC or MAM. PMID:25423308

  9. [Guideline for integrated geriatric assessment].

    PubMed

    Reyes-Morales, Hortensia; Doubova, Svetlana Vladislavovna; García-González, José Juan; Espinosa-Aguilar, Amilcar; Jiménez-Uribe, Rodrigo; Peña-Valdovinos, Abel; Mendoza-Núñez, Víctor Manuel

    2009-01-01

    A clinical practice guideline was developed as a response to the increasing of elderly in Mexican population due to the epidemiological transition; this instrument allows the assessment of health conditions for people from 60 years of age and older, and it can be a tool for helping family physicians and nurses in providing care for the main health problems of this group of age. The guideline for gerontologic assessment includes six principal health priorities in older people (loss of vision, difficulty to hear, falls or problems walking, nutritional disorders, memory difficulties, and sleep disorders); additionally, another four components for assessment are revised (medication use, physical functionality, quality of life, and social support). Simple recommendations for detection, diagnosis and management of these problems in primary care settings are presented. PMID:20141660

  10. Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

    PubMed

    Carpenter, Christopher R; Platts-Mills, Timothy F

    2013-02-01

    Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

  11. The acute medical management of detained Somali pirates and their captives.

    PubMed

    Schranz, Craig

    2012-09-01

    Over the last several years, piracy off the coast of East Africa has resulted in significant risks to merchant vessels and their crews. There have been multiple instances of both pirates being detained and captives being liberated by military vessels. The unique health concerns of this population have been minimally studied and military health providers must be prepared to identify and manage potential medical conditions. In an attempt to provide further guidance for providers, this article reviews the limited available literature and identifies potential health concerns of pirates and recently released captives. In addition to traumatic injuries, specific medical concerns that must be considered include infectious disease, wound management, dehydration, hypothermia, malnutrition, electrolyte disturbance, and potential psychiatric conditions. Infectious disease is also a major threat. Malaria, tuberculosis, and intestinal parasites likely pose the greatest risk. A careful medical screening along with an extensive intake history and physical examination are essential for rapid identification and initial management of this unique population.

  12. [Specialized training in geriatric psychiatry during residency in France].

    PubMed

    Lepetit, Alexis; Lavigne, Benjamin; Legros, Emilie; Herrmann, Mathieu; Sebbane, Déborah

    2014-09-01

    Aging of the population is a growing concern in developed countries. Therefore, geriatric psychiatry has gradually emerged from general psychiatry. Many names have been proposed to term this sub-specialty: old age psychiatry (OAP), psychogeriatrics, geropsychiatry. A working group of the French federation of psychiatric trainees (AFFEP) set up an inventory of the theoretical instruction and clinical practice of OAP during the training of psychiatrists in France. Methods. A survey of both academic teaching and practical training for OAP was carried out in the 28 local AFFEP representatives of every French medical residency district, including overseas. We assessed the supply of general courses and seminars devoted to OAP during the training of French residents in psychiatry, and the offer of university or inter-university degrees as well as the possibility of specialized internship in every residency district. Results. 96% of French medical residency districts offered general courses of OAP with a mean volume of 11.5 hours along the four years of psychiatric training in France. Fifty percent of medical residency districts proposed at least one seminar devoted to OAP. Half of medical residency districts also offer a specialized university or inter-university degree. Concerning clinical practice, 86% of medical residency districts had one internship dedicated to OAP, in 39% of cases in teaching hospitals. Conclusion. Nationwide, there is an overall effort to make OAP available to French psychiatric residents by general courses and internship, but some disparity appeared in academic teaching (i.e. offering seminars and university/inter-university degrees) according to various residency districts.

  13. Medical informatics: an essential tool for health sciences research in acute care.

    PubMed

    Li, Man; Pickering, Brian W; Smith, Vernon D; Hadzikadic, Mirsad; Gajic, Ognjen; Herasevich, Vitaly

    2009-10-01

    Medical Informatics has become an important tool in modern health care practice and research. In the present article we outline the challenges and opportunities associated with the implementation of electronic medical records (EMR) in complex environments such as intensive care units (ICU). We share our initial experience in the design, maintenance and application of a customized critical care, Microsoft SQL based, research warehouse, ICU DataMart. ICU DataMart integrates clinical and administrative data from heterogeneous sources within the EMR to support research and practice improvement in the ICUs. Examples of intelligent alarms -- "sniffers", administrative reports, decision support and clinical research applications are presented.

  14. The Filipino Nursing Students' Dilemmas in Geriatric Care

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Severance, Janet S.; Yeo, Gwen

    2006-01-01

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

  16. A Study of Geriatric Training Programs in the United States.

    ERIC Educational Resources Information Center

    Robbins, Alan S.; And Others

    1982-01-01

    A detailed analysis of geriatric education at the undergraduate, graduate, and fellowship levels is reported. Data on the type of training sites, educational activities, and clinical interaction at different levels of training are presented. The results suggest that there is a need for high-quality geriatric programs at all levels. (Author/MLW)

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

    PubMed

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

    2014-12-01

    The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs.

  18. Circulating biomarker responses to medical management vs. mechanical circulatory support in severe inotrope‐dependent acute heart failure

    PubMed Central

    Meredith, Anna J.; Dai, Darlene L. Y.; Chen, Virginia; Hollander, Zsuzsanna; Ng, Raymond; Kaan, Annemarie; Tebbutt, Scott; Ramanathan, Krishnan; Cheung, Anson

    2015-01-01

    Abstract Background Severe inotrope‐dependent acute heart failure (AHF) is associated with poor clinical outcomes. There are currently no well‐defined blood biomarkers of response to treatment that can guide management or identify recovery in this patient population. In the present study, we characterized the levels of novel and emerging circulating biomarkers of heart failure in patients with AHF over the first 30 days of medical management or mechanical circulatory support (MCS). We hypothesized a shared a plasma proteomic treatment response would be identifiable in both patient groups, representing reversal of the AHF phenotype. Methods and results Time course plasma samples of the first 30 days of therapy, obtained from patients managed medically (n = 8) or with implantable MCS (n = 5), underwent semi‐targeted and candidate biomarker analyses, using multiple reaction monitoring (MRM) mass spectrometry, antibody arrays, and enzyme‐linked immunosorbent assays. Differentially expressed proteins were identified using robust limma for MRM and antibody array data. Patients managed medically or with implantable MCS had a shared proteomic signature of six plasma proteins: circulating cardiotrophin 1, cardiac troponin T, clusterin, and dickopff 1 increased, while levels of C‐reactive protein and growth differentiation factor 15 decreased in both groups over the 30 day time course. Conclusions We have characterized the temporal proteomic signature of clinical recovery in AHF patients managed medically or with MCS, over the first 30 days of treatment. Changes in biomarker expression over the time course of treatment may provide a basis for understanding the biological basis of AHF, potentially identifying novel markers and pathophysiologic mechanisms of recovery.

  19. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-03-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians.

  20. An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients

    PubMed Central

    Samama, Meyer Michel; Kleber, Franz-Xaver

    2006-01-01

    Both the recently updated consensus guidelines published by the American College of Chest Physicians, and the International Union of Angiology recommend thromboprophylaxis with either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in medical patients at risk of VTE. However, no guidance is given regarding the appropriate dosing regimens that should be used for thromboprophylaxis in this patient group. LMWH (enoxaparin and dalteparin) and UFH have been shown to be effective for thromboprophylaxis in at-risk hospitalized medical patients. Although LMWH once daily (o.d.) has been shown to be as effective as UFH three times daily (t.i.d.) for thromboprophylaxis in at-risk medical patients, there are no data to show that UFH twice daily (b.i.d) is as effective as either LMWH o.d. or UFH t.i.d. On the basis of currently available evidence, the LMWHs enoxaparin and dalteparin are more attractive alternatives to UFH for the prevention of VTE in hospitalized medical patients because of their convenient once-daily administration and better safety profile, demonstrated in terms of reduced bleeding, HIT, and other adverse events. PMID:16817957

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

    PubMed

    Kates, Stephen L

    2014-05-01

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

  2. Feasibility of Spanish-language acquisition for acute medical care providers: novel curriculum for emergency medicine residencies

    PubMed Central

    Grall, Kristi H; Panchal, Ashish R; Chuffe, Eliud; Stoneking, Lisa R

    2016-01-01

    Introduction Language and cultural barriers are detriments to quality health care. In acute medical settings, these barriers are more pronounced, which can lead to poor patient outcomes. Materials and methods We implemented a longitudinal Spanish-language immersion curriculum for emergency medicine (EM) resident physicians. This curriculum includes language and cultural instruction, and is integrated into the weekly EM didactic conference, longitudinal over the entire 3-year residency program. Language proficiency was assessed at baseline and annually on the Interagency Language Roundtable (ILR) scale, via an oral exam conducted by the same trained examiner each time. The objective of the curriculum was improvement of resident language skills to ILR level 1+ by year 3. Significance was evaluated through repeated-measures analysis of variance. Results The curriculum was launched in July 2010 and followed through June 2012 (n=16). After 1 year, 38% had improved over one ILR level, with 50% achieving ILR 1+ or above. After year 2, 100% had improved over one level, with 90% achieving the objective level of ILR 1+. Mean ILR improved significantly from baseline, year 1, and year 2 (F=55, df =1; P<0.001). Conclusion Implementation of a longitudinal, integrated Spanish-immersion curriculum is feasible and improves language skills in EM residents. The curriculum improved EM-resident language proficiency above the goal in just 2 years. Further studies will focus on the effect of language acquisition on patient care in acute settings. PMID:26929679

  3. Geriatric vestibulopathy assessment and management

    PubMed Central

    Furman, Joseph M.; Raz, Yael; Whitney, Susan L.

    2016-01-01

    Purpose of review This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals. Recent findings Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60–69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling. Summary When caring for an older dizzy patient always assess medication use, perform a Dix–Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation. PMID:20613528

  4. Epidemiological studies on radiation carcinogenesis in human populations following acute exposure: nuclear explosions and medical radiation

    SciTech Connect

    Fabrikant, J.I.

    1981-05-01

    The current knowledge of the carcinogenic effect of radiation in man is considered. The discussion is restricted to dose-incidence data in humans, particularly to certain of those epidemiological studies of human populations that are used most frequently for risk estimation for low-dose radiation carcinogenesis in man. Emphasis is placed solely on those surveys concerned with nuclear explosions and medical exposures. (ACR)

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

    PubMed Central

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

    2015-01-01

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

  6. Prognostic implications of optimal medical therapy in patients undergoing percutaneous coronary intervention for acute coronary syndrome in octogenarians.

    PubMed

    Anzai, Atsushi; Maekawa, Yuichiro; Kodaira, Masaki; Mogi, Satoshi; Arai, Takahide; Kawakami, Takashi; Kanazawa, Hideaki; Hayashida, Kentaro; Yuasa, Shinsuke; Kawamura, Akio; Fukuda, Keiichi

    2015-03-01

    The proportion of elderly acute coronary syndrome (ACS) patients who receive optimal medical therapy (OMT) after percutaneous coronary intervention (PCI) and whether OMT affects their long-term outcomes remain unclear. We retrospectively investigated 405 ACS patients who underwent stent implantation between 2005 and 2009, and compared the outcomes between patients <80 years of age vs. ≥80 years of age. The prescription rate of the recommended medical agents for ACS in both groups during hospitalization and 2 years after admission was also retrieved. Among the enrolled study population, 75 patients (19%) were aged ≥80 years. These elderly patients had a higher 2-year mortality compared with patients aged <80 years group. The prescription rate of beta-blockers, angiotensin-blocking drugs, and statins tended to be lower in patients aged ≥80 years than in those aged <80 years. Furthermore, among patients ≥80 years of age, those who received OMT had better clinical outcome of 2-year mortality compared to those without OMT. Elderly patients with ACS treated by PCI are at substantially higher risk of adverse events than younger patients. However, they are less likely to receive OMT. PCI with OMT might improve the clinical outcomes of elderly ACS patients.

  7. Why should medical students study Social Gerontology?

    PubMed

    Tinker, Anthea; Hussain, Labib; D'Cruz, Jack Lilly; Tai, William Yee Seng; Zaidman, Sebastian

    2016-03-01

    The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients.

  8. The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance.

    PubMed

    Meads, Catherine; Lovato, Eleonora; Longworth, Louise

    2015-12-01

    As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft(®) monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft(®) to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft(®) was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft(®) remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft(®). The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft(®) and this has been published

  9. The educational challenge of dental geriatrics.

    PubMed

    MacEntee, Michael I

    2010-01-01

    Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population. PMID:20061525

  10. Effectiveness of a geriatric day hospital.

    PubMed Central

    Eagle, D J; Guyatt, G H; Patterson, C; Turpie, I; Sackett, B; Singer, J

    1991-01-01

    OBJECTIVE: To determine whether there is a difference in the quality of life between elderly patients managed in a day hospital and those receiving conventional care. DESIGN: Randomized controlled trial; assessment upon entry to study and at 3, 6 and 12 months afterward. SETTING: Geriatrician referral-based secondary care. PATIENTS: A total of 113 consecutively referred elderly patients with deteriorating functional status believed to have rehabilitation potential; 55 were assessed and treated by an interdisciplinary team in a day hospital (treatment group), and 58 were assessed in an inpatient unit or an outpatient clinic or were discharged early with appropriate community services (control group). OUTCOME MEASURES: Barthel Index, Rand Questionnaire, Global Health Question and Geriatric Quality of Life Questionnaire (GQLQ). MAIN RESULTS: Eight study subjects and four control subjects died; the difference was insignificant. Functional status deteriorated over time in the two groups; although the difference was not significant there was less deterioration in the control group. The GQLQ scores indicated no significant difference between the two groups in the ability to perform daily living activities and in the alleviation of symptoms over time but did show a trend favouring the control group. The GQLQ scores did indicate a significant difference in favour of the control group in the effect of treatment on emotions (p = 0.009). CONCLUSION: The care received at the day hospital did not improve functional status or quality of life of elderly patients as compared with the otherwise excellent geriatric outpatient care. PMID:1998929

  11. Geriatric assessment unit in a teaching hospital.

    PubMed Central

    Robertson, D.; Christ, L. W.; Stalder, L. J.

    1982-01-01

    A geriatric assessment unit has been in operation in a Canadian teaching hospital since October 1979. In the first 15 months of operation there were 203 admissions involving 153 persons aged 65 years or older, many of whom were impaired both physically and mentally.In many cases these patients could be discharged back to the community following assessment and rehabilitation. Only a few had to be placed immediately in extended care facilities. The mean stay in the unit was less than 3 weeks. There was a mortality of 3% among patients in the unit. For older persons who present with complex health problems a geriatric assessment unit provides an environment for comprehensive assessment, treatment and rehabilitation. A thorough assessment at, or preferably before, the point at which their health breaks down enables older people to return to and remain in the community and helps to prevent them from being admitted to an institution while they are still able to function with reasonable independence. PMID:7074507

  12. The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents

    PubMed Central

    Yardimci, Bulent; Aran, Sinan N.; Ozkaya, Ismail; Aksoy, Sevki M.; Demir, Tarik; Tezcan, Gulsen; Kaptanoglu, Aysegul Y.

    2016-01-01

    Objectives: To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test. Methods: This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed. Results: A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass. Conclusions: The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents. PMID:27652361

  13. [Outpatient geriatric rehabilitation - the structural and process quality of a geriatric mobile service team and a community-based outpatient center].

    PubMed

    Meinck, M; Freigang, K; John, B; Keitel, C; Puls, E; Robra, B-P

    2002-10-01

    The trial "Outpatient Geriatric Rehabilitation (AMBRA)" has been launched to compare two outpatient rehabilitation models close to their place of residence or at home: a mobile rehabilitation team based at a geriatric hospital department and a community-based outpatient rehabilitation center run by GPs. Primary analyses concerning structural and process quality of the models are presented in this paper. They refer to medical features and factors associated with care which were assessed at the beginning of the rehabilitation procedures and during intervention. The models include 60 patients attended by the mobile rehabilitation team and 76 patients attended by the outpatient rehabilitation centre. The patients are suffering from multiple illnesses and are limited in their daily activities. Both teams co-ordinate interdisciplinary rehabilitation programs with an average of 50 therapeutic units per patient under medical supervision. The programs' focus is on physiotherapy and occupational therapy and, if indicated, on logotherapy. Psychosocial and health promotional offers are hardly integrated into the procedures. The mobile rehabilitation team on average cares for patients with better cognitive functions (Mini-Mental State Examination) but worse abilities to cope in daily life (Barthel index) than the outpatient rehabilitation team. These differences between rehabilitation groups remain significant after multivariate consideration of sociodemographic, morbidity and process factors. However, differences in mobility (Tinetti Test) can be explained by these variables. The future comparison of results of the rehabilitation programs must therefore consider the different baseline levels and determinants between both groups.

  14. Medical Management of Acute Radiation Syndromes : Comparison of Antiradiation Vaccine and Antioxidants radioprotection potency.

    NASA Astrophysics Data System (ADS)

    Maliev, Slava; Popov, Dmitri; Lisenkov, Nikolai

    Introduction: This experimental study of biological effects of the Antiradiation Vaccine and Antioxidants which were used for prophylaxis and treatment of the Acute Radiation Syndromes caused by high doses of the low-LET radiation. An important role of Reactive Oxyden Species (Singlet oxygen, hydroxyl radicals, superoxide anions and bio-radicals)in development of the Acute Radiation Syndromes could be defined as a "central dogma" of radiobiology. Oxida-tion and damages of lipids, proteins, DNA, and RNA are playing active role in development of postradiation apoptosis. However, the therapeutic role of antioxidants in modification of a postradiation injury caused by high doses of radiation remains controversial.Previous stud-ies had revealed that antioxidants did not increase a survival rate of mammals with severe forms of the Acute Radiation Syndromes caused by High Doses of the low-LET radiation. The Antiradiation Vaccine(ARV) contains toxoid forms of the Radiation Toxins(RT) from the Specific Radiation Determinants Group (SRD). The RT SRD has toxic and antigenic prop-erties at the same time and stimulates a specific antibody elaboration and humoral response form activated acquired immune system. The blocking antiradiation antibodies induce an im-munologically specific effect and have inhibiting effects on radiation induced neuro-toxicity, vascular-toxicity, gastrointestinal toxcity, hematopoietic toxicity, and radiation induced cytol-ysis of selected groups of cells that are sensitive to radiation. Methods and materials: Scheme of experiments: 1. Irradiated animals with development of Cerebrovascular ARS (Cv-ARS), Cardiovascular ARS (Cr-ARS) Gastrointestinal ARS(GI-ARS), Hematopoietic ARS (H-ARS) -control -were treated with placebo administration. 2. Irradiated animals were treated with antioxidants prophylaxisis and treatment of Cv-ARS, Cr-SRS, GI-ARS, Hp-ARS forms of the ARS. 3. irradiated animals were treated with radioprotection by Antiradiation Vaccine

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

    PubMed

    Resnick, Neil M; Radulovich, Nichole

    2014-03-01

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

  16. Medical Management of Acute Radiation Syndromes : Comparison of Antiradiation Vaccine and Antioxidants radioprotection potency.

    NASA Astrophysics Data System (ADS)

    Maliev, Slava; Popov, Dmitri; Lisenkov, Nikolai

    Introduction: This experimental study of biological effects of the Antiradiation Vaccine and Antioxidants which were used for prophylaxis and treatment of the Acute Radiation Syndromes caused by high doses of the low-LET radiation. An important role of Reactive Oxyden Species (Singlet oxygen, hydroxyl radicals, superoxide anions and bio-radicals)in development of the Acute Radiation Syndromes could be defined as a "central dogma" of radiobiology. Oxida-tion and damages of lipids, proteins, DNA, and RNA are playing active role in development of postradiation apoptosis. However, the therapeutic role of antioxidants in modification of a postradiation injury caused by high doses of radiation remains controversial.Previous stud-ies had revealed that antioxidants did not increase a survival rate of mammals with severe forms of the Acute Radiation Syndromes caused by High Doses of the low-LET radiation. The Antiradiation Vaccine(ARV) contains toxoid forms of the Radiation Toxins(RT) from the Specific Radiation Determinants Group (SRD). The RT SRD has toxic and antigenic prop-erties at the same time and stimulates a specific antibody elaboration and humoral response form activated acquired immune system. The blocking antiradiation antibodies induce an im-munologically specific effect and have inhibiting effects on radiation induced neuro-toxicity, vascular-toxicity, gastrointestinal toxcity, hematopoietic toxicity, and radiation induced cytol-ysis of selected groups of cells that are sensitive to radiation. Methods and materials: Scheme of experiments: 1. Irradiated animals with development of Cerebrovascular ARS (Cv-ARS), Cardiovascular ARS (Cr-ARS) Gastrointestinal ARS(GI-ARS), Hematopoietic ARS (H-ARS) -control -were treated with placebo administration. 2. Irradiated animals were treated with antioxidants prophylaxisis and treatment of Cv-ARS, Cr-SRS, GI-ARS, Hp-ARS forms of the ARS. 3. irradiated animals were treated with radioprotection by Antiradiation Vaccine

  17. The BRIGHTEN Program: Implementation and Evaluation of a Program to Bridge Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking

    ERIC Educational Resources Information Center

    Emery, Erin E.; Lapidos, Stan; Eisenstein, Amy R.; Ivan, Iulia I.; Golden, Robyn L.

    2012-01-01

    Purpose: To demonstrate the feasibility of the BRIGHTEN Program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), an interdisciplinary team intervention for assessing and treating older adults for depression in outpatient primary and specialty medical clinics. The BRIGHTEN team collaborates "virtually"…

  18. Key decisions in marketing plan formulation for geriatric services.

    PubMed

    Van Doren, D C; Durney, J R; Darby, C M

    1993-01-01

    The scope of geriatric services offered by health care institutions has expanded from the traditional hospital, long-term care, and home care services to include a variety of community services in an effort to promote the institution and provide a continuum of care for the elderly. The purposes of this article are to analyze why marketing of geriatric services is such a significant issue in health care today, to identify why a comprehensive management tool such as Service Line Management may be a key component for successful development and marketing of geriatric services, and to analyze the key decisions facing management when formulating a marketing plan.

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

    PubMed

    Zhao, Bo; Grivas, Petros D

    2015-11-01

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

  20. Epidemiological studies on radiation carcinogenesis in human populations following acute exposure: nuclear explosions and medical radiation

    SciTech Connect

    Fabrikant, J.I.

    1982-08-01

    The present review provides an understanding of our current knowledge of the carcinogenic effect of low-dose radiation in man, and surveys the epidemiological studies of human populations exposed to nuclear explosions and medical radiation. Discussion centers on the contributions of quantitative epidemiology to present knowledge, the reliability of the dose-incidence data, and those relevant epidemiological studies that provide the most useful information for risk estimation of cancer-induction in man. Reference is made to dose-incidence relationships from laboratory animal experiments where they may obtain for problems and difficulties in extrapolation from data obtained at high doses to low doses, and from animal data to the human situation. The paper describes the methods of application of such epidemiological data for estimation of excess risk of radiation-induced cancer in exposed human populations, and discusses the strengths and limitations of epidemiology in guiding radiation protection philosophy and public health policy.

  1. [Acute Leaflet Arrest in St. Jude Medical Regent Mechanical Aortic Valve;Report of a Case].

    PubMed

    Morishima, Yuji; Arakaki, Katsuya

    2015-06-01

    A 61-year-old woman was diagnosed with combined valvular disease and atrial fibrillation, and was admitted for surgery. We performed double valve replacement, tricuspid annuloplasty and maze operation. At the operation, a 19 mm St. Jude Medical Regent valve was implanted with non-everting mattress sutures at the aortic supra-annular position after mitral valve replacement. Although pulling down of the prosthesis into the aortic annulus was easy, the leaflets were unable to open at all in a movability test. After removing several stitches on the mitral side of the hinges, the subvalvular tissue was seen bulging into the hinge, hindering the free movement. The prosthesis was removed and replaced with a 17 mm Regent valve by the same technique. The patient's postoperative course was uneventful. We suggest it is necessary to pay special attention to the structural characteristics of the prosthesis. PMID:26066878

  2. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes.

    PubMed

    Thompson, Katherine; Shi, Sandra; Kiraly, Carmela

    2016-06-01

    Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential.

  3. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.

    PubMed

    Parham, Kourosh; Kuchel, George A

    2016-02-01

    Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach. PMID:26804483

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

    PubMed

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

    2014-01-01

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

  5. The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients.

    PubMed

    Malyuk, Rhonda E; Wong, Carol; Buree, Barbara; Kang, Arvind; Kang, Nirmal

    2012-01-01

    The purpose of this study was to determine the impact of identifying and treating infections on functional outcomes and length of stay (LOS). Our retrospective naturalistic study reviewed all new admissions to a tertiary geriatric psychiatry teaching hospital from 2003 to 2007. Over this four-year period, 390 patients were admitted and discharged with 21% (85) of patients identified as having infections on admission. Those with infections were compared to the group without to determine and compare clinical characteristics. Factors included in analysis were: age, gender, diagnoses, medical comorbidity, neuropsychiatric symptoms, functional outcomes, medications and LOS. Both groups were similar in gender, psychiatric diagnoses and severity of dementia. Those requiring antibiotics for treatment of infections on admission, were older (p=0.003), had poorer baseline function (p=0.005) and higher medical comorbidity (p<0.001). At discharge, the group with infections showed greater functional improvement (p<0.001), particularly in mobility (p=0.005) and cognition (p=0.046), and had a shorter LOS (p=0.02). We conclude that a significant number of patients in tertiary geriatric services continue to have infections on admission. Early identification and treatment of infections can result in improved function and decreased LOS. PMID:21377222

  6. Virtual Reality as an Adjunctive Non-pharmacologic Analgesic for Acute Burn Pain During Medical Procedures

    PubMed Central

    Chambers, Gloria T.; Meyer, Walter J.; Arceneaux, Lisa L.; Russell, William J.; Seibel, Eric J.; Richards, Todd L.; Sharar, Sam R.; Patterson, David R.

    2015-01-01

    Introduction Excessive pain during medical procedures is a widespread problem but is especially problematic during daily wound care of patients with severe burn injuries. Methods Burn patients report 35–50% reductions in procedural pain while in a distracting immersive virtual reality, and fMRI brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients’ attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors. Conclusions We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future. PMID:21264690

  7. Physiology Considerations in the Geriatric Patient

    PubMed Central

    Alvis, Bret D.; Hughes, Christopher G.

    2015-01-01

    Synopsis A person’s physiology is ever-changing at the structural, functional, and molecular levels as they age, and every major organ system experiences physiologic change with time. The changes to the nervous system result mostly in cognitive impairments, the cardiovascular system result in higher blood pressures with lower cardiac output, the respiratory system result in a reduction of arterial oxyhemoglobin, the gastrointestinal system result in delayed gastric emptying with a reduction of hepatic metabolism, and the renal system experiences a diminished glomerular filtration rate. All these changes are variable from patient to patient; however, combined, they create a complex physiological condition. This unique physiology must be taken into consideration for a geriatric patient undergoing general anesthesia. PMID:26315630

  8. The Physician Assistant in Geriatric Long-Term Care

    ERIC Educational Resources Information Center

    Becker, Robert G.

    1976-01-01

    The Physician Assistant (PA) is a new health-care professional who is trained to function as a "physician extender." The author's experience with 71 PA students and graduate PA's at the Jewish Institute for Geriatric Care is described. (Author)

  9. Comprehensive geriatric assessment in the emergency department

    PubMed Central

    Ellis, Graham; Marshall, Trudi; Ritchie, Claire

    2014-01-01

    Changing global demography is resulting in older people presenting to emergency departments (EDs) in greater numbers than ever before. They present with greater urgency and are more likely to be admitted to hospital or re-attend and utilize greater resources. They experience longer waits for care and are less likely to be satisfied with their experiences. Not only that, but older people suffer poorer health outcomes after ED attendance, with higher mortality rates and greater dependence in activities of daily living or rates of admission to nursing homes. Older people’s assessment and management in the ED can be complex, time consuming, and require specialist skills. The interplay of multiple comorbidities and functional decline result in the complex state of frailty that can predispose to poor health outcomes and greater care needs. Older people with frailty may present to services in an atypical fashion requiring detailed, multidimensional, and increasingly multidisciplinary care to provide the correct diagnosis and management as well as appropriate placement for ongoing care or admission avoidance. Specific challenges such as delirium, functional decline, or carer strain need to be screened for and managed appropriately. Identifying patients with specific frailty syndromes can be critical to identifying those at highest risk of poor outcomes and most likely to benefit from further specialist interventions. Models of care are evolving that aim to deliver multidimensional assessment and management by multidisciplinary specialist care teams (comprehensive geriatric assessment). Increasingly, these models are demonstrating improved outcomes, including admission avoidance or reduced death and dependence. Delivering this in the ED is an evolving area of practice that adapts the principles of geriatric medicine for the urgent-care environment. PMID:25473275

  10. Medical management of acute ocular hypertension in a western screech owl (Megascops kennicottii).

    PubMed

    Jayson, Stephanie; Sanchez-Migallon Guzman, David; Petritz, Olivia; Freeman, Kate; Maggs, David J

    2014-03-01

    A wild young adult western screech owl (Megascops kennicottii) of unknown sex was presented for evaluation of an abnormal left eye (OS). Ophthalmic examination OS revealed raised intraocular pressure (37 mm Hg; reference interval 7-16 mm Hg), mydriasis, conjunctival and episcleral hyperemia, shallow anterior chamber due to anterior displacement of the lens and iris, rubeosis iridis, and engorgement of the pecten. The intraocular pressure in the right eye (OD) was 11 mm Hg. Multifocal pale, variably translucent, curvilinear to vermiform opacities were observed in the medial and ventral peripheral regions of the retina OD, consistent with focal retinitis. Mannitol (0.46 g/kg IV) was administered over 10 minutes. Forty minutes later, the intraocular pressure was 27 mm Hg OS and 13 mm Hg OD. Dorzolamide (one drop OS q12h), diclofenac (one drop OU q8-12h), and meloxicam (0.5 mg/kg PO q24h) were administered for 3 days. The intraocular pressure OS was within normal limits 1 day (11 mm Hg), 7 days (13 mm Hg), and 4 weeks (14 mm Hg) after this treatment. Complications arising during hospitalization and rehabilitation included superficial corneal ulceration of both eyes presumed secondary to trauma on being caught and superficial damage to a talon. The owl was released after a period of rehabilitation. Characteristic presenting signs as well as response to therapy suggest aqueous misdirection was the cause of ocular hypertension in this owl. To our knowledge, this is the first report of suspected aqueous misdirection and its medical management in a raptor.

  11. CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit

    PubMed Central

    Oppenheimer, Maylin; Rezwan, Nivin

    2015-01-01

    Urinary tract infections (UTI) are a common presentation in a medical assessment unit, and we wanted to check compliance with hospital guidelines for antibiotic prescribing in patients presenting to hospital with urinary tract infection. The guidelines are based on local organisms and sensitivities. A retrospective audit of 40 patient records with positive urine cultures from July to August 2013 showed that 20% of patients with culture confirmed UTI were not given antibiotics at all. Of those prescribed antibiotics, 25% were non-compliant with local policy, and nearly one in two patients received more than one antibiotic. Furthermore, stop dates were not stated on 77% of the drug charts and duration of treatment ranged from one to 11 days. Interventions were then introduced in the form of group teaching sessions, proactive checks by Trust pharmacists and widely distributed posters, and the same data sets collected for April to March 2014 to assess for efficacy of the interventions. On re-auditing, 35% patients were not prescribed any antibiotics. However, compliance with local policy was 100%, including 100% drug charts having a stop/review date stated. The overall duration of treatment now ranged from one to seven days, and fewer than one in four patients had more than one antibiotic. Our results showed that improvement was needed in antibiotic stewardship, in particular with regards to compliance with the local guidelines and documentation of prescription. We have demonstrated that it is possible to improve compliance through teaching, by displaying information prominently, and vigilance by the clinical team. The outcome of this is a decreased number and duration of antibiotics prescribed, which has benefits for the patients, the hospital, and the community as a whole. Further work would include interventions to improve the number of patients who are missing antibiotic prescriptions altogether. PMID:26734357

  12. CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit.

    PubMed

    Oppenheimer, Maylin; Rezwan, Nivin

    2015-01-01

    Urinary tract infections (UTI) are a common presentation in a medical assessment unit, and we wanted to check compliance with hospital guidelines for antibiotic prescribing in patients presenting to hospital with urinary tract infection. The guidelines are based on local organisms and sensitivities. A retrospective audit of 40 patient records with positive urine cultures from July to August 2013 showed that 20% of patients with culture confirmed UTI were not given antibiotics at all. Of those prescribed antibiotics, 25% were non-compliant with local policy, and nearly one in two patients received more than one antibiotic. Furthermore, stop dates were not stated on 77% of the drug charts and duration of treatment ranged from one to 11 days. Interventions were then introduced in the form of group teaching sessions, proactive checks by Trust pharmacists and widely distributed posters, and the same data sets collected for April to March 2014 to assess for efficacy of the interventions. On re-auditing, 35% patients were not prescribed any antibiotics. However, compliance with local policy was 100%, including 100% drug charts having a stop/review date stated. The overall duration of treatment now ranged from one to seven days, and fewer than one in four patients had more than one antibiotic. Our results showed that improvement was needed in antibiotic stewardship, in particular with regards to compliance with the local guidelines and documentation of prescription. We have demonstrated that it is possible to improve compliance through teaching, by displaying information prominently, and vigilance by the clinical team. The outcome of this is a decreased number and duration of antibiotics prescribed, which has benefits for the patients, the hospital, and the community as a whole. Further work would include interventions to improve the number of patients who are missing antibiotic prescriptions altogether. PMID:26734357

  13. In vivo demonstration of ultrasound power delivery to charge implanted medical devices via acute and survival porcine studies.

    PubMed

    Radziemski, Leon; Makin, Inder Raj S

    2016-01-01

    Animal studies are an important step in proving the utility and safety of an ultrasound based implanted battery recharging system. To this end an Ultrasound Electrical Recharging System (USER™) was developed and tested. Experiments in vitro demonstrated power deliveries at the battery of up to 600 mW through 10-15 mm of tissue, 50 mW of power available at tissue depths of up to 50 mm, and the feasibility of using transducers bonded to titanium as used in medical implants. Acute in vivo studies in a porcine model were used to test reliability of power delivery, temperature excursions, and cooling techniques. The culminating five-week survival study involved repeated battery charging, a total of 10.5h of ultrasound exposure of the intervening living tissue, with an average RF input to electrical charging efficiency of 20%. This study was potentially the first long term cumulative living-tissue exposure using transcutaneous ultrasound power transmission to an implanted receiver in situ. Histology of the exposed tissue showed changes attributable primarily due to surgical implantation of the prototype device, and no damage due to the ultrasound exposure. The in vivo results are indicative of the potential safe delivery of ultrasound energy for a defined set of source conditions for charging batteries within implants.

  14. Problems with eating and nutrition: geriatric self-learning module.

    PubMed

    Lee, Virginia K

    2004-12-01

    The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalizedelders. The Problems With Eating and Nutrition: Geriatric Self-Learning Module is published here, along with a post test. This is the second in a four-part publication of self-learning modules.

  15. [Contribution of psychoanalysis to geriatric care for institutionalized patients].

    PubMed

    Charazac, Pierre-Marie

    2014-06-01

    The contribution of psychoanalysis to geriatric care in nursing home is discussed in three directions: its conception of care, specially on its negative sides; its implication in geriatric units, in their conception and in the analysis of their management of care; the holding of care-givers and nurses by making clear what we call transference and conter-transference and their reflection on their function.

  16. Predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge

    PubMed Central

    Johari, Nuruljannah; Manaf, Zahara Abdul; Ibrahim, Norhayati; Shahar, Suzana; Mustafa, Norlaila

    2016-01-01

    Purpose Diabetes mellitus is prevalent among older adults, and affects their quality of life. Furthermore, the number is growing as the elderly population increases. Thus, this study aims to explore the predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge in Malaysia. Methods A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life. Results Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R2=0.633, F(3, 67)=38.462; P<0.001), whereas depression and instrumental activities of daily living contributed to 55.8% of the variability in psychological domain (R2=0.558, F(2, 68)=42.953; P<0.001). Social support and cognitive status were the determinants of social relationship (R2=0.539, F(2, 68)=39.763; P<0.001) and also for the environmental domain of the quality of life (R2=0.496, F(2, 68)=33.403; P<0.001). Conclusion The findings indicated different predictors for each domain in the quality of life among hospitalized geriatric patients with diabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients’ quality of life. PMID:27799751

  17. [The nessesarity of a geriatric care improvement for population of the country side in Ulyanovsk area].

    PubMed

    Kabakova, T A; Balandin, A N; Gorbunov, V I

    2005-01-01

    In this article there is data which shows the results of Ulyanovsk area country side older persons complex medical tests. 345 of 60-85 years old patients were tested (204 males, 141 females). Result--there are no healthy people in the tested group. In average each old patient has 4.3 diseases--in 3.1 times more than adults do. The most of the sicknesses are the case rates of the blood-transporting, eyes and ears ones and bone-muscle system. The level of a medical care tolerance war analyzed by 172 old patients application checking. Result is a high tolerance of a medical care. So, it's nessesary to improve a specialized geriatric services. PMID:16075690

  18. Geriatric Care as an Introductory Pharmacy Practice Experience

    PubMed Central

    Boyce, Eric; Patel, Rajul A.

    2011-01-01

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

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

    PubMed

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

    1997-08-01

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

  20. Why do doctors choose a career in geriatric medicine?

    PubMed

    Briggs, Sally; Atkins, Recia; Playfer, Jeremy; Corrado, Oliver J

    2006-01-01

    Reforms to postgraduate training in the U.K. may affect recruitment to geriatric medicine. In 2005, a questionnaire survey was undertaken to determine the factors favouring geriatric medicine as a career choice and whether these might be used to influence recruitment. In all, 1036 responses to the questionnaire were received (response rate 56.4%); 4% of the respondents decided to specialise in geriatric medicine as students, 3.8% of consultants and 8.6% of registrars decided as pre-registration house officers while 39% of consultants and 7% of registrars chose geriatric medicine while a middle grade in another specialty. The strongest influences on choice were clinical aspects of the specialty (34.1%) and inspirational seniors (26.2%). However, 9.2% of consultants and 10.1% of registrars subsequently regretted their career decision. Geriatric medicine seems to be a career choice for doctors of increasing maturity and including more posts in foundation programmes may not improve recruitment as anticipated. Although a small number of doctors regretted choosing geriatric medicine as a career, this was rarely to do with core aspects of the specialty. PMID:17080894

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

    PubMed Central

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

    2016-01-01

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

  2. Clinicians’ and Patients’ Experiences and Satisfaction with Unscheduled, Nighttime, Internet-based Video Conferencing for Assessing Acute Medical Problems in a Nursing Facility

    PubMed Central

    Weiner, Michael; Schadow, Gunther; Lindbergh, Donald; Warvel, Jill; Abernathy, Greg; Perkins, Susan M.; Fyffe, Joanne; Dexter, Paul R.; McDonald, Clement J.

    2003-01-01

    Videoconferencing between patients and their physicians can increase patients’ access to healthcare. Unscheduled videoconferencing can benefit patients with acute medical problems but has not been studied extensively. We conducted a clinical trial of unscheduled, nighttime videoconferencing in a nursing home, where on-call physicians usually provide care by telephone from remote locations. Although most calls for medical problems did not lead to videoconferencing, physicians and nursing-home residents were satisfied with videoconferencing when it did occur, and physicians reported that making medical decisions was easier with videoconferencing. Videoconferencing was most often conducted to assess residents with changes in mental status, abnormal laboratory values, or falls. Physicians often lacked immediate access to videoconferencing equipment when medical problems with residents occurred. This application could benefit from improved access and portability of equipment. PMID:14728265

  3. Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data.

    PubMed

    Gray, Leonard C; Fatehi, Farhad; Martin-Khan, Melinda; Peel, Nancye M; Smith, Anthony C

    2016-06-01

    Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals. PMID:27321617

  4. A System Design for Studying Geriatric Patients with Dementia and Hypertension Based on Daily Living Information

    NASA Astrophysics Data System (ADS)

    Xu, Weifeng; Betz, Willian R.; Frezza, Stephen T.; Liu, Yunkai

    2011-08-01

    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.

  5. Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis.

    PubMed

    Ojino, Mayo; Ishii, Masami

    2014-02-01

    The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the "Fukushima Accident." In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care. This

  6. How Medicare Part D Benefit Phases Affect Adherence with Evidence-Based Medications Following Acute Myocardial Infarction

    PubMed Central

    Stuart, Bruce; Davidoff, Amy; Erten, Mujde; Gottlieb, Stephen S; Dai, Mingliang; Shaffer, Thomas; Zuckerman, Ilene H; Simoni-Wastila, Linda; Bryant-Comstock, Lynda; Shenolikar, Rahul

    2013-01-01

    Objective. Assess impact of Medicare Part D benefit phases on adherence with evidence-based medications after hospitalization for an acute myocardial infarction. Data Source. Random 5 percent sample of Medicare beneficiaries. Study Design. Difference-in-difference analysis of drug adherence by AMI patients stratified by low-income subsidy (LIS) status and benefit phase. Data Collection/Extraction Methods. Subjects were identified with an AMI diagnosis in Medicare Part A files between April 2006 and December 2007 and followed until December 2008 or death (N = 8,900). Adherence was measured as percent of days covered (PDC) per month with four drug classes used in AMI treatment: angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, statins, and clopidogrel. Monthly exposure to Part D benefit phases was calculated from flags on each Part D claim. Principal Findings. For non-LIS enrollees, transitioning from the initial coverage phase into the Part D coverage gap was associated with statistically significant reductions in mean PDC for all four drug classes: statins (−7.8 percent), clopidogrel (−7.0 percent), beta-blockers (−5.9 percent), and ACE inhibitor/ARBs (−5.1 percent). There were no significant changes in adherence associated with transitioning from the gap to the catastrophic coverage phase. Conclusions. As the Part D doughnut hole is gradually filled in by 2020, Medicare Part D enrollees with critical diseases such as AMI who rely heavily on brand name drugs are likely to exhibit modest increases in adherence. Those reliant on generic drugs are less likely to be affected. PMID:23742013

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

    PubMed

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

    2014-09-01

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

  8. Research ethics issues in geriatric psychiatry.

    PubMed

    Dunn, Laura B; Misra, Sahana

    2009-06-01

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

  9. A patient-centered research agenda for the care of the acutely ill older patient

    PubMed Central

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  10. Altered Synchronizations among Neural Networks in Geriatric Depression.

    PubMed

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

    2015-01-01

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

  11. Altered Synchronizations among Neural Networks in Geriatric Depression.

    PubMed

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

    2015-01-01

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

  12. A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

    PubMed Central

    2010-01-01

    Background Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Methods Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. Results The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. Conclusions The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors. PMID:20370928

  13. 75 FR 32490 - Issues in the Development of Medical Products for the Prophylaxis and/or Treatment of Acute...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... Prophylaxis and/or Treatment of Acute Antibody Mediated Rejection in Kidney Transplant Recipients; Public... prophylaxis and/or treatment of acute antibody mediated rejection (AMR) in kidney transplant recipients. This public workshop is intended to provide information for and gain perspective from health care...

  14. Summary of Closed Circuit Television Activities in Medical Education.

    ERIC Educational Resources Information Center

    London Univ. (England). Inst. of Education.

    This 1967 summary of closed circuit television (CCTV) activities in medical education presents descriptive information on 35 different medical institutions in Great Britain. Specific data on CCTV are offered by institution, equipment, and uses under each medical field: anatomy, anaesthetics, geriatrics, medicine, obstretrics and gynaecology,…

  15. [The expertise evaluation of organization of rendering of acute, emergency and urgent medical care in rural regions of Novosibirsk oblast'].

    PubMed

    Ivaninskiĭ, O I; Sharapov, I V; Sadovoĭ, M A

    2013-01-01

    The most problematic spheres in the resource support of emergency medical care to rural residents are the completeness of staff of physicians in rural medical surgeries, community hospitals and departments of emergency medical care in central district hospitals. The provision of feldsher obstetrics posts with sanitary motor transport and medical equipment is yet another problematic sphere. The main troubles during provision of emergency medical care at feldsher obstetrics posts are related to surgery treatment. The organization of emergency and urgent medical care suffers of many unresolved problems related to informational program support at feldsher obstetrics posts, polyclinics of central district hospitals.

  16. Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis.

    PubMed

    Ojino, Mayo; Ishii, Masami

    2014-02-01

    The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the "Fukushima Accident." In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care. This

  17. Reconstruction of the Radiation Emergency Medical System From the Acute to the Sub-acute Phases After the Fukushima Nuclear Power Plant Crisis

    PubMed Central

    OJINO, Mayo; ISHII, Masami

    2014-01-01

    The radiation emergency medical system in Japan ceased to function as a result of the accident at the Fukushima Daiichi Nuclear Power Plant, which has commonly become known as the “Fukushima Accident.” In this paper, we review the reconstruction processes of the radiation emergency medical system in order of events and examine the ongoing challenges to overcoming deficiencies and reinforcing the system by reviewing relevant literature, including the official documents of the investigation committees of the National Diet of Japan, the Japanese government, and the Tokyo Electric Power Company, as well as technical papers written by the doctors involved in radiation emergency medical activities in Fukushima. Our review has revealed that the reconstruction was achieved in 6 stages from March 11 to July 1, 2011: (1) Re-establishment of an off-site center (March 13), (2) Re-establishment of a secondary radiation emergency hospital (March 14), (3) Reconstruction of the initial response system for radiation emergency care (April 2), (4) Reinforcement of the off-site center and stationing of disaster medical advisors at the off-site center (April 4), (5) Reinforcement of the medical care system and an increase in the number of hospitals for non-contaminated patients (From April 2 to June 23), and (6) Enhancement of the medical care system in the Fukushima Nuclear Power Plant and the construction of a new medical care system, involving both industrial medicine and emergency medicine (July 1). Medical resources such as voluntary efforts, academic societies, a local community medical system and university hospitals involved in medical care activities on 6 stages originally had not planned. In the future, radiation emergency medical systems should be evaluated with these 6 stages as a basis, in order to reinforce and enrich both the existing and backup systems so that minimal harm will come to nuclear power plant workers or evacuees and that they will receive proper care

  18. Co-Prescription of QT-Interval Prolonging Drugs: An Analysis in a Large Cohort of Geriatric Patients

    PubMed Central

    Schächtele, Simone; Tümena, Thomas; Gaßmann, Karl-Günter; Fromm, Martin F.; Maas, Renke

    2016-01-01

    Background Drug-induced QT-interval prolongation is associated with occurrence of potentially fatal Torsades de Pointes arrhythmias (TdP). So far, data regarding the overall burden of QT-interval prolonging drugs (QT-drugs) in geriatric patients are limited. Objective This study was performed to assess the individual burden of QT-interval prolonging drugs (QT-drugs) in geriatric polymedicated patients and to identify the most frequent and risky combinations of QT-drugs. Methods In the discharge medication of geriatric patients between July 2009 and June 2013 from the Geriatrics in Bavaria–Database (GiB-DAT) (co)-prescriptions of QT-drugs were investigated. QT-drugs were classified according to a publicly available reference site (CredibleMeds®) as ALL-QT-drugs (associated with any QT-risk) or High-risk-QT-drugs (corresponding to QT-drugs with known risk of Torsades de Pointes according to CredibleMeds®) and in addition as SmPC-high-risk-QT-drugs (according to the German prescribing information (SmPC) contraindicated co-prescription with other QT-drugs). Results Of a cohort of 130,434 geriatric patients (mean age 81 years, 67% women), prescribed a median of 8 drugs, 76,594 patients (58.7%) received at least one ALL-QT-drug. Co-prescriptions of two or more ALL-QT-drugs were observed in 28,768 (22.1%) patients. Particularly risky co-prescriptions of High-risk-QT-drugs or SmPC-high-risk-QT-drugs with at least on further QT-drug occurred in 55.9% (N = 12,633) and 54.2% (N = 12,429) of these patients, respectively. Consideration of SmPCs (SmPC-high-risk-QT-drugs) allowed the identification of an additional 15% (N = 3,999) patients taking a risky combination that was not covered by the commonly used CredibleMeds® classification. Only 20 drug-drug combinations accounted for more than 90% of these potentially most dangerous co-prescriptions. Conclusion In a geriatric study population co-prescriptions of two and more QT-drugs were common. A considerable proportion of QT

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Simonson, William; Pratt, Clara Collette

    1982-01-01

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

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

    PubMed

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

    2015-09-15

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

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

    PubMed Central

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

    2015-01-01

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

  4. Posttraumatic stress following acute medical trauma in children: A proposed model of bio-psycho-social processes during the peri-trauma period

    PubMed Central

    Marsac, Meghan L.; Kassam-Adams, Nancy; Delahanty, Douglas L.; Widaman, Keith; Barakat, Lamia P.

    2015-01-01

    Millions of children worldwide experience acute medical events. Children’s responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions, and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed. PMID:25217001

  5. Economic viability of geriatric hip fracture centers.

    PubMed

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

    2013-12-01

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

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

    PubMed

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

    2015-09-01

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

  7. A longitudinal, experiential quality improvement curriculum meeting ACGME competencies for geriatrics fellows: lessons learned.

    PubMed

    Callahan, Kathryn E; Rogers, Matthew T; Lovato, James F; Fernandez, Helen M

    2013-01-01

    Quality improvement (QI) initiatives are critical in the care of older adults who are more vulnerable to substandard care. QI education meets aspects of core Accreditation Council of Graduate Medical Education competencies and prepares learners for the rising focus on performance measurement in health care. The authors developed, implemented, and evaluated a QI curriculum for geriatrics fellows. The evidence-based curriculum included didactics and a fellow-led QI intervention based on audit and feedback through the Practice Improvement Module in Care of the Vulnerable Elderly. QI knowledge, attitudes, and behaviors were assessed before and after the improvement project. Fellows' knowledge of QI improved (p = .0156), but behavior did not change significantly across a short-term improvement project. A structured focus group with fellows revealed themes of accountability and the importance of interprofessional teamwork in QI. QI education for geriatrics fellows can be feasible, well received, and prepare future physician leaders for patient-centered care, performance measurement, and effecting systems change.

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

    PubMed

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

    2015-09-01

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

  9. Vitamin B12 deficit and development of geriatric syndromes.

    PubMed

    Ocampo Chaparro, José Mauricio

    2013-01-01

    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.

  10. Decanting geriatric institutions: development of a patient assessment methodology.

    PubMed

    Warner, M M

    1991-01-01

    Many elderly people in both developing and developed countries are institutionalized--often irrespective of whether their ability to function requires it. Increased attention is now being given to prospects for decanting geriatric institutions and planning new forms of care. However, methodologic difficulties exist, it being hard to determine how much of the institutionalized elderly population could be effectively accommodated by alternate forms of care requiring certain levels of social, physical, and mental capacity. The procedure described in this article, based on work performed in Barbados, seeks to assess the eligibility of an existing institutionalized geriatric population for alternate types of care, thereby laying the groundwork for future planning.

  11. Research Priorities in Geriatric Palliative Care: Policy Initiatives

    PubMed Central

    Unroe, Kathleen T.

    2013-01-01

    Abstract Coordinated palliative care matched to patient needs improves quality of care for vulnerable patients with serious illness and reduces costly use of hospitals and emergency departments. Unfortunately, there is a disconnect in translating geriatric palliative care models and principles into policy and widespread practice. Gaps in policy-relevant research are addressed, including implementation strategies to scale up existing care models, the role of palliative care and geriatrics in health care payment reform efforts, development of quality measures for complex patients, strategies to address workforce shortages, and an approach to hospice reform. PMID:24147877

  12. Maximizing the potential of internships in gerontology and geriatrics.

    PubMed

    Karasik, Rona J

    2009-01-01

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

  13. [GERIATRIC ETHNOGRAPHY PROCESSES ASSOCIATED WITH SUPERVISION OF GERONTOLOGICAL TEAMS].

    PubMed

    Danel, Paula Mara

    2015-01-01

    In this paper the sociocultural dimensions of residences for seniors are analyzed. The approach to the reality of these institutions has been made across assessment processes and monitoring sustained for more than 15 years in the Buenos Aires area. In this production are recreated and are reviewed the conceptual categories that form the conceptual matrix of research conducted between 2005 and 2007, comparing the experiences of supervision held between 2011 and 2015. Are worked from the idea of that the geriatric ethnography, to come to visualize the studies about what happens in geriatric residence, modes approaches, the expected body shapes, the narratives that they hegemonize senses on service users and workers.

  14. Falls prevention for elders in acute care: an evidence-based nursing practice initiative.

    PubMed

    Murphy, Tamara H; Labonte, Paula; Klock, Monica; Houser, Larry

    2008-01-01

    The purpose of this article is to describe and measure the impact of a multifaceted program developed to reduce the falls rate on an acute medical unit at an academic tertiary care center. According to national benchmarks, this unit was one of the hospital's top 3 units for numbers of falls for several years. That distinction drove the hospital and unit leadership and a staff-led unit practice council to develop an evidence-based intervention plan. Interventions included a campaign to raise geriatric awareness, creation of "falls tool boxes," education of staff and family, and implementation of a structured hourly patient rounds schedule. The success of these interventions is discussed, including the effect on the falls rate benchmark. The discussion addresses implications and outcomes associated with the empowerment of nursing staff to respond to benchmarking measures, implement evidence-based practices, and use the same benchmarking procedure to measure outcomes.

  15. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain

    PubMed Central

    Leininger, Brent D; Evans, Roni; Bronfort, Gert

    2014-01-01

    Objective The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain and global satisfaction. Methods This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical physician for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and 1) change in neck pain (primary outcome of the randomized trial) and 2) global satisfaction were assessed using Pearson’s correlation and multiple linear regression. Results Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. SMT and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r=−0.75 to −0.77, R2= 0.55 to 0.56) had a stronger relationship with global satisfaction compared to satisfaction with information provided (r=−0.65 to 0.67, R2=0.39 to 0.46). The relationship between satisfaction with care and neck pain was weak (r=0.17 to 0.38, R2=0.08 to 0.21). Conclusions Individuals with acute/subacute neck pain were more satisfied with specific aspects of care from SMT delivered by doctors of chiropractic or HEA interventions compared to MED prescribed by a medical physician. PMID:25199824

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2016-01-01

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

  20. Impact of Prior Use of Four Preventive Medications on Outcomes in Patients Hospitalized for Acute Coronary Syndrome--Results from CPACS-2 Study

    PubMed Central

    Du, Xin; Li, Shenshen; Ji, Jiachao; Patel, Anushka; Gao, Runlin; Wu, Yangfeng

    2016-01-01

    Background It is widely reported that long-term use of four preventive medications (antiplatelet agents, angiotensin converting enzyme inhibitor / angiotensin receptor blocker, statin and beta-blockers) reduce the risk of subsequent acute coronary syndromes (ACS). It is unclear whether these four medications benefit patients who develop ACS despite its use. Methods and Results Logistic regression and propensity-score was applied among 14790 ACS patients to assess the association between prior use of four preventive medications and in-hospital outcomes including severity of disease at presentation (type of ACS, systolic blood pressure <90 mmHg, and heart rate> = 100 beats/min), complicating arrhythmia and major adverse cardiovascular events (MACEs, including all deaths, non-fatal myocardial infarction or re-infarction, and non-fatal stroke). Prior use of each of the four medications was significantly associated with less severity of disease (ORs ranged from 0.40 to 0.82, all P<0.05), less arrhythmia (ORs ranged from 0.45 to 0.64, all P<0.05), and reduced risk of MACEs (ORs ranged from 0.59 to 0.73, all P<0.05) during hospitalization. Multiple variable-adjusted ORs of MACEs were 0.77, 0.67, 0.48 and 0.59 respectively in patients with 1, 2, 3 and 4 medications in comparison with patients with none, and other clinical outcomes showed the same trend (P for trend < 0.05). Conclusions Among ACS patients in our study, those with prior use of four preventive medications presented with less disease severity, developed less arrhythmia and had a lower risk of in-hospital MACEs. The value of taking these medications may beyond just preventing occurrence of the disease. PMID:27626640

  1. Emergency Cardiac Surgery in Patients with Acute Coronary Syndromes: A Review of the Evidence and Perioperative Implications of Medical and Mechanical Therapeutics

    PubMed Central

    Brown, Charles; Joshi, Brijen; Faraday, Nauder; Shah, Ashish; Yuh, David; Rade, Jeffrey J.; Hogue, Charles W.

    2011-01-01

    Patients with acute coronary syndromes who require emergency cardiac surgery present complex management challenges. The early administration of antiplatelet and antithrombotic drugs has improved overall survival for patients with acute myocardial infarction, but to achieve maximal benefit, these drugs are given before coronary anatomy is known and before the decision to perform percutaneous coronary interventions or surgical revascularization has been made. A major bleeding event secondary to these drugs is associated with a high rate of death in medically treated patients with acute coronary syndrome possibly due to subsequent withholding of antiplatelet and antithrombotic therapies that otherwise reduce the rate of death, stroke, or recurrent myocardial infarcation. Whether the added risk of bleeding and blood transfusion in cardiac surgical patients receiving such potent antiplatelet or antithrombotic therapy before surgery specifically for acute coronary syndromes affects long-term mortality has not been clearly established. For patients who do proceed to surgery, strategies to minimize bleeding include stopping the anticoagulation therapy and considering platelet and/or coagulation factor transfusion and possibly rFVIIa administration for refractory bleeding. Mechanical hemodynamic support has emerged as an important option for patients with acute coronary syndromes in cardiogenic shock. For these patients, perioperative considerations include maintaining appropriate anticoagulation, ensuring suitable device flow, and periodically verifying correct device placement. Data supporting the use of these devices are derived from small trials that did not address long-term postoperative outcomes. Future directions of research will seek to optimize the balance between reducing myocardial ischemic risk with antiplatelet and antithrombotics versus the higher rate perioperative bleeding by better risk-stratifying surgical candidates and by assessing the effectiveness of

  2. Emergency cardiac surgery in patients with acute coronary syndromes: a review of the evidence and perioperative implications of medical and mechanical therapeutics.

    PubMed

    Brown, Charles; Joshi, Brijen; Faraday, Nauder; Shah, Ashish; Yuh, David; Rade, Jeffrey J; Hogue, Charles W

    2011-04-01

    Patients with acute coronary syndromes who require emergency cardiac surgery present complex management challenges. The early administration of antiplatelet and antithrombotic drugs has improved overall survival for patients with acute myocardial infarction, but to achieve maximal benefit, these drugs are given before coronary anatomy is known and before the decision to perform percutaneous coronary interventions or surgical revascularization has been made. A major bleeding event secondary to these drugs is associated with a high rate of death in medically treated patients with acute coronary syndrome possibly because of subsequent withholding of antiplatelet and antithrombotic therapies that otherwise reduce the rate of death, stroke, or recurrent myocardial infarction. Whether the added risk of bleeding and blood transfusion in cardiac surgical patients receiving such potent antiplatelet or antithrombotic therapy before surgery specifically for acute coronary syndromes affects long-term mortality has not been clearly established. For patients who do proceed to surgery, strategies to minimize bleeding include stopping the anticoagulation therapy and considering platelet and/or coagulation factor transfusion and possibly recombinant-activated factor VIIa administration for refractory bleeding. Mechanical hemodynamic support has emerged as an important option for patients with acute coronary syndromes in cardiogenic shock. For these patients, perioperative considerations include maintaining appropriate anticoagulation, ensuring suitable device flow, and periodically verifying correct device placement. Data supporting the use of these devices are derived from small trials that did not address long-term postoperative outcomes. Future directions of research will seek to optimize the balance between reducing myocardial ischemic risk with antiplatelet and antithrombotics versus the higher rate perioperative bleeding by better risk stratifying surgical candidates and by

  3. Geriatric emergency medicine service: a novel approach to an emerging trend.

    PubMed

    Argento, Vivian; Calder, Gina; Ferrigno, Rockman; Skudlarska, Beata

    2014-01-01

    Many studies have described benefits to patients from geriatric care in the emergency department (ED), yet few geriatric emergency departments exist nationally. As our nation ages and health care financing for these patients becomes more complex, it will be crucial for hospitals to develop ED services that address the needs of our sickest and frailest patients. In this article, we report on our experiences using advanced practice registered nurses (APRNs) embedded in an established ED. Our geriatric emergency medicine service (GEMS(SM)) model has improved patient satisfaction rates and decreased time spent in the ED. It has increased volume of geriatric patients in our hospital by 6%. Strong executive support for geriatric services has established our hospital as a local leader in geriatric emergency medicine. The program is fiscally neutral and serves a frail vulnerable population. We have improved healthcare for our seniors and believe this model of geriatric emergency care can easily be replicated nationally. PMID:25672060

  4. Geriatric emergency medicine service: a novel approach to an emerging trend.

    PubMed

    Argento, Vivian; Calder, Gina; Ferrigno, Rockman; Skudlarska, Beata

    2014-01-01

    Many studies have described benefits to patients from geriatric care in the emergency department (ED), yet few geriatric emergency departments exist nationally. As our nation ages and health care financing for these patients becomes more complex, it will be crucial for hospitals to develop ED services that address the needs of our sickest and frailest patients. In this article, we report on our experiences using advanced practice registered nurses (APRNs) embedded in an established ED. Our geriatric emergency medicine service (GEMS(SM)) model has improved patient satisfaction rates and decreased time spent in the ED. It has increased volume of geriatric patients in our hospital by 6%. Strong executive support for geriatric services has established our hospital as a local leader in geriatric emergency medicine. The program is fiscally neutral and serves a frail vulnerable population. We have improved healthcare for our seniors and believe this model of geriatric emergency care can easily be replicated nationally.

  5. [Acute lumbago due to the manual lifting of patients in wards: prevalence and incidence data].

    PubMed

    Colombini, D; Cianci, E; Panciera, D; Martinelli, M; Venturi, E; Giammartini, P; Ricci, M G; Menoni, O; Battevi, N

    1999-01-01

    The aim of the study was to measure the occurrence (prevalence and incidence) of episodes of acute low back pain (definite effect) in a wide sample of health workers assisting disabled patients. A questionnaire was used for the study both of true acute low back pain and of episodes of ingravescent low back pain controlled pharmacologically at the onset. The questionnaire identified overall acute and pharmacologically controlled episodes occurring in the previous 12 months, both in the course of work and over the whole life of the subject. Appropriately trained operators administered the questionnaire to 551 subjects; 481 valid answer cards were obtained from 372 females and 109 males working in medical, orthopaedic and geriatric departments. 75.4% of the sample had high exposure index levels for patient lifting. The prevalence of true acute low back pain was 9% in males and 11% in females referred to the previous 12 months. Taking acute true and pharmacologically controlled low back pain together the prevalences rose to 13.8% for males and 26.9% in females. Data from the reference populations showed that acute low back pain did not exceed 3% on average in the previous year. Since work seniority in the hospital wards was known, the incidences were calculated, giving 7.9% in females and 5.29% in males for acute low back pain, and 19% in females and 3.49% in males for pharmacologically controlled low back pain. Considering the number of episodes in 100 workers/year, acute low back pain alone reached prevalences of 13-14%. This therefore appears to confirm the positive ratio between episodes of low back pain and duties involving assistance to disabled patients.

  6. Graduate and undergraduate geriatric dentistry education in a selected dental school in Japan.

    PubMed

    Kitagawa, N; Sato, Y; Komabayashi, T

    2011-11-01

    Geriatric dentistry and its instruction are critical in a rapidly ageing population. Japan is the world's fastest-ageing society, and thus, geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed at evaluating geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographical data and local information were collected. Descriptive and statistical analyses (Fisher and chi-squared test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There were no significant differences found between the number of public and private dental schools with geriatric dentistry departments (P = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students' geriatric dental education curriculum (P = 0.077). Graduate geriatric education is unique because it is a 4-year PhD course of study; there is neither a master's degree programme nor a certificate programme in geriatric dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry.

  7. Implementing a multidimensional geriatric curriculum in a physical medicine and rehabilitation residency program.

    PubMed

    Faulk, Clinton E; Lee, Tae Joon; Musick, David

    2012-10-01

    Residency training in physical medicine and rehabilitation may not contain a formal curriculum in geriatric patient care. A multidimensional geriatric curriculum to third and fourth year physical medicine and rehabilitation residents was implemented to enhance their knowledge in and attitude toward geriatrics. The curriculum consisted of a 12-wk clinical rotation at various sites of geriatric care including outpatient geriatric clinic, skilled nursing facility, continuing care retirement community, and home visits. Six online self-learning modules and multiple didactic sessions were also created. The residents' knowledge and attitude were assessed by pretest and posttest design using the Geriatric Knowledge Test, the Geriatric Attitude Scale, and the Attitudes Toward Teamwork in Healthcare Scale. In addition, the residents completed rotation evaluations to rate their learning experiences. Ten postgraduate year 3 and 4 physical medicine and rehabilitation residents participated in the geriatric curriculum, which included a required rotation. The Geriatric Knowledge Test score at baseline was 67.2%. With the completion of the curriculum, the Geriatric Knowledge Test scores showed improvement to 72.7%, although not statistically significant. The residents showed more favorable attitudes toward the geriatric population and interdisciplinary teamwork as measured by the Geriatric Attitude Scale and the Attitudes Toward Teamwork in Healthcare Scale. Overall, they rated the learning experiences highly on a 1-9 rating scale, with 9 being the highest rating; the residents assigned an average rating of 7.06 to specific learning activities within the rotation and an average rating of 6.89 to the organizational aspects of the rotation itself. The implementation of this geriatric curriculum allowed for improved geriatric training in physical medicine and rehabilitation residents.

  8. Identifying landmark articles for advancing the practice of geriatrics.

    PubMed

    Vaughan, Camille P; Fowler, Rachel; Goodman, Richard A; Graves, Taylor R; Flacker, Jonathan M; Johnson, Theodore M

    2014-11-01

    Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice.

  9. [A partnership for the benefit of patients in geriatrics].

    PubMed

    Jacquin-Mourain, Nicole

    2015-02-01

    In geriatrics, with the longer life expectancy and the growing number of neurodegenerative diseases, the need for care is increasing and working together is fundamental. The nurse/healthcare assistant partnership is the guarantor of improving patients' quality of care. PMID:26144824

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

    ERIC Educational Resources Information Center

    Levkoff, Sue; And Others

    1996-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  12. Maximizing the Potential of Internships in Gerontology and Geriatrics

    ERIC Educational Resources Information Center

    Karasik, Rona J.

    2009-01-01

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

  13. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries

    PubMed Central

    Bajwa, Sukhminder Jit Singh

    2015-01-01

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

  14. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Braun, Kathryn L.; Rose, Charles L.

    1987-01-01

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

  16. Interpretive Accuracy of Two MMPI Short Forms with Geriatric Patients.

    ERIC Educational Resources Information Center

    Newmark, Charles S.; And Others

    1982-01-01

    Assessed and compared the interpretive accuracy of the standard Minnesota Multiphasic Personality Inventory (MMPI) and two MMPI short forms with a sample of geriatric psychiatric inpatients. Psychiatric teams evaluated the accuracy of the interpretation. Standard form interpretations were rated significantly greater than the interpretations…

  17. A Web-Based Framework for Improving Geriatric Education

    ERIC Educational Resources Information Center

    Hirth, Victor A.; Hajjar, Ihab

    2004-01-01

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

  18. Development of the Geriatric Oral Health Assessment Index.

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; Dolan, Teresa A.

    1990-01-01

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

  19. Use of Readers Theater to Enhance Interdisciplinary Geriatric Education

    ERIC Educational Resources Information Center

    MacRae, Nancy; Pardue, Karen T.

    2007-01-01

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

  20. Geriatric Experience for Pharmacy Students: Classroom Instruction Applied during Externship.

    ERIC Educational Resources Information Center

    Mason, Holly L.; And Others

    1984-01-01

    During the Fall 1982 semester, Purdue pharmacy students elected to participate in a 24 class-hour course that stressed instruction and practical experience in geriatric pharmacy services. A major course project was the step-by-step development and presentation of an inservice educational program. (Author/MLW)

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

    PubMed

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

    2012-02-01

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

  2. Evaluation of a Distance Learning Course in Geriatric Interdisciplinary Teaming.

    ERIC Educational Resources Information Center

    Coogle, Constance L.; Parham, Iris A.; Welleford, E. Ayn; Netting, F. Ellen

    2002-01-01

    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…

  3. [Hospital-at-home in older patients: a scoping review on opportunities of developing comprehensive geriatric assessment based services].

    PubMed

    Mas, Miquel Àngel; Santaeugènia, Sebastià

    2015-01-01

    This scoping review focused on the opportunity of developing new hospital-at-home schemes in our health systems adapted to older patients with complex conditions due to acute illness. A review was conducted on articles including, randomized controlled trials, systematic reviews and meta-analysis in PubMed and Cochrane Library, from January 1990 to July 2013. Search terms were: hospital-at-home, Early Supported Discharge, hospital in the home and home hospitalization. An analysis was performed to include: the intervention model (admission avoidance or early discharge), age, diagnosis, main inclusion criteria and intervention characteristics (disciplines involved, duration of intervention, main outcomes and objectives). It is concluded that there are several models of hospital-at-home care, with favorable clinical outcomes. The majority of teams in our country focused on acute health care in the less elderly with chronic diseases. Other schemes based on comprehensive geriatric assessment and interdisciplinary teams specialized in complex interventions are also highlighted. The development of comprehensive geriatric assessment based hospital-at-home care by teams led by geriatricians is an opportunity to develop alternatives to conventional hospitalization interventions tailored to older patients.

  4. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults with Major Depression

    ERIC Educational Resources Information Center

    Dimidjian, Sona; Hollon, Steven D.; Dobson, Keith S.; Schmaling, Karen B.; Kohlenberg, Robert J.; Addis, Michael E.; Gallop, Robert; McGlinchey, Joseph B.; Markley, David K.; Gollan, Jackie K.; Atkins, David C.; Dunner, David L.; Jacobson, Neil S.

    2006-01-01

    Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have…

  5. Profile of acute lower respiratory tract infection in children under fourteen years of age at Nepal Medical College Teaching Hospital (NMCTH).

    PubMed

    Rijal, P; Sharma, A; Shrestha, S; Upadhyay, S

    2011-03-01

    The purpose of this study was to find out the current pattern and prevalence of acute lower respiratory tract infections in children at Nepal Medical College Teaching Hospital in Katmandu, Nepal. A retrospective study was done in 73 children, admitted to the Pediatric ward over a period of one year from January 2010-December 2010. This study showed, 52.0% children below two years of age had acute lower respiratory tract infections, where 68.4% had pneumonia and 31.6% had acute bronchiolitis. The prevalence of infections was 58.9% in male children. The occurrence of infections was common in January and April month. Pneumonia was detected in 37.7% children with malnutrition. The most common presenting symptoms was fever observed in 90.4%, cough in 71.2% and fast breathing in 34.2% children. The WBC count was high in 47.9% children, out of which 43.8% had pneumonia and 4.1% had bronchiolitis. Increased neutrophil count in 36.9% and increased ESR in 50.7% seen in patients only with pneumonia. Chest x-ray showed, lobar pneumonia in 45.2% children where right middle zone was most commonly involved in 42.4% patients. Six (8.2%) children were diagnosed as pulmonary tuberculosis. The average duration of hospital stay was 6 days. PMID:21991705

  6. Comprehensive geriatric assessment of a mental health service user with safeguarding needs.

    PubMed

    North, Chris

    2016-05-27

    This is the final article in a short series that presents case study examples of the use of comprehensive geriatric assessment (CGA) in different clinical settings. CGA is a holistic model that is used to determine frail older people's medical and mental health status, as well as any functional, social and environmental issues that might affect their care. When undertaken by nurses, it can enable individualised planning for health, safety and wellbeing. This article explores the case of an older woman living in the community who was receiving support from a number of health and social care services and who had significant safeguarding needs. It highlights the complexity of caring for patients with physical and mental health conditions. CGA can link these conditions and needs together to allow a better understanding of their effects on the patient. The risks of significant transitions in care are also highlighted, along with recommendations for the provision of multidisciplinary care in community settings.

  7. A computer-aided diagnosis system for geriatrics assessment and frailty evaluation.

    PubMed

    Vairaktarakis, Charalampos; Tsiamis, Vasilis; Soursou, Georgia; Lekkas, Filippos; Nikolopoulou, Markella; Vasileiadou, Emmanouilia; Premtsis, Konstantinos; Alexiou, Athanasios

    2015-01-01

    It is a common knowledge that frailty is a condition associated with getting older, and it has been considered as highly prevalent as far as falls, disability, hospitalization, and mortality are concerned. At the present time a standardized definition has not yet been established. With that in mind and for frailty being of a vital importance as a term identifying geriatric symptoms, we pursued to embody the well-known 70-scale CSHA Frailty index of the Canadian Study of Health and Aging in a Clinical Decision Support System, after categorizing and expanding it. The proposed categorization in this chapter can be helpful for usage by patients and their relatives, care givers, and medical doctors.

  8. Segmentation and Classification of Bone Marrow Cells Images Using Contextual Information for Medical Diagnosis of Acute Leukemias.

    PubMed

    Reta, Carolina; Altamirano, Leopoldo; Gonzalez, Jesus A; Diaz-Hernandez, Raquel; Peregrina, Hayde; Olmos, Ivan; Alonso, Jose E; Lobato, Ruben

    2015-01-01

    Morphological identification of acute leukemia is a powerful tool used by hematologists to determine the family of such a disease. In some cases, experienced physicians are even able to determine the leukemia subtype of the sample. However, the identification process may have error rates up to 40% (when classifying acute leukemia subtypes) depending on the physician's experience and the sample quality. This problem raises the need to create automatic tools that provide hematologists with a second opinion during the classification process. Our research presents a contextual analysis methodology for the detection of acute leukemia subtypes from bone marrow cells images. We propose a cells separation algorithm to break up overlapped regions. In this phase, we achieved an average accuracy of 95% in the evaluation of the segmentation process. In a second phase, we extract descriptive features to the nucleus and cytoplasm obtained in the segmentation phase in order to classify leukemia families and subtypes. We finally created a decision algorithm that provides an automatic diagnosis for a patient. In our experiments, we achieved an overall accuracy of 92% in the supervised classification of acute leukemia families, 84% for the lymphoblastic subtypes, and 92% for the myeloblastic subtypes. Finally, we achieved accuracies of 95% in the diagnosis of leukemia families and 90% in the diagnosis of leukemia subtypes.

  9. Segmentation and Classification of Bone Marrow Cells Images Using Contextual Information for Medical Diagnosis of Acute Leukemias

    PubMed Central

    Reta, Carolina; Altamirano, Leopoldo; Gonzalez, Jesus A.; Diaz-Hernandez, Raquel; Peregrina, Hayde; Olmos, Ivan; Alonso, Jose E.; Lobato, Ruben

    2015-01-01

    Morphological identification of acute leukemia is a powerful tool used by hematologists to determine the family of such a disease. In some cases, experienced physicians are even able to determine the leukemia subtype of the sample. However, the identification process may have error rates up to 40% (when classifying acute leukemia subtypes) depending on the physician’s experience and the sample quality. This problem raises the need to create automatic tools that provide hematologists with a second opinion during the classification process. Our research presents a contextual analysis methodology for the detection of acute leukemia subtypes from bone marrow cells images. We propose a cells separation algorithm to break up overlapped regions. In this phase, we achieved an average accuracy of 95% in the evaluation of the segmentation process. In a second phase, we extract descriptive features to the nucleus and cytoplasm obtained in the segmentation phase in order to classify leukemia families and subtypes. We finally created a decision algorithm that provides an automatic diagnosis for a patient. In our experiments, we achieved an overall accuracy of 92% in the supervised classification of acute leukemia families, 84% for the lymphoblastic subtypes, and 92% for the myeloblastic subtypes. Finally, we achieved accuracies of 95% in the diagnosis of leukemia families and 90% in the diagnosis of leukemia subtypes. PMID:26107374

  10. Long-Term Results of Fixed High-Dose I-131 Treatment for Toxic Nodular Goiter: Higher Euthyroidism Rates in Geriatric Patients

    PubMed Central

    Aktaş, Gül Ege; Turoğlu, Halil Turgut; Erdil, Tanju Yusuf; İnanır, Sabahat; Dede, Fuat

    2015-01-01

    Objective: Geriatric patient population has special importance due to particular challenges. In addition to the increase in incidence of toxic nodular goiter (TNG) with age, it has a high incidence in the regions of low-medium iodine intake such as in our country. The aim of this study was to evaluate the overall outcome of high fixed dose radioiodine (RAI) therapy, and investigate the particular differences in the geriatric patient population. Methods: One hundred and three TNG patients treated with high dose I-131 (370-740 MBq) were retrospectively reviewed. The baseline characteristics; age, gender, scintigraphic patterns and thyroid function tests before and after treatment, as well as follow-up, duration of antithyroid drug (ATD) medication and achievement of euthyroid or hypothyroid state were evaluated. The patient population was divided into two groups as those=>65 years and those who were younger, in order to assess the effect of age. Results: Treatment success was 90% with single dose RAI therapy. Hyperthyroidism was treated in 7±7, 2 months after RAI administration. At the end of the first year, overall hypothyroidism rate was 30% and euthyroid state was achieved in 70% of patients. Age was found to be the only statistically significant variable effecting outcome. A higher ratio of euthyroidism was achieved in the geriatric patient population. Conclusion: High fixed dose I-131 treatment should be preferred in geriatric TNG patients in order to treat persistent hyperthyroidism rapidly. The result of this study suggests that high fixed dose RAI therapy is a successful modality in treating TNG, and high rates of euthyroidism can be achieved in geriatric patients. PMID:27529883

  11. Four Models of Medical Education about Elder Mistreatment.

    ERIC Educational Resources Information Center

    Heath, John M.; Dyer, Carmel B.; Kerzner, Lawrence J.; Mosqueda, Laura; Murphy, Carole

    2002-01-01

    Describe four models of incorporating elder-mistreatment curriculum and collaboration with adult protective services into geriatrics medical education. Draws on efforts at the University of Medicine and Dentistry of New Jersey--Robert Wood Johnson Medical School; the University of California, Irvine College of Medicine; Hennepin County Medical…

  12. [Gerodontology consultation in geriatric facilities: general health status (I)].

    PubMed

    Katsoulis, Joannis; Huber, Sandra; Mericske-Stern, Regina

    2009-01-01

    Dental undertreatment is often seen in the older population. This is particularly true for the elderly living in nursing homes and geriatric hospitals. The progression of chronic diseases results in loss of their independence. They rely on daily support and care due to physical or mental impairment. The visit of a dentist in private praxis becomes difficult or impossible and is a logistic problem. These elderly patients are often not aware of oral and dental problems or these are not addressed. The geriatric hospital Bern, Ziegler, has integrated dental care in the concept of physical rehabilitation of geriatric patients. A total of 139 patients received dental treatment in the years 2005/2006. Their mean age was 83 years, but the segment with > 85 years of age amounted to 46%. The general health examinations reveald multiple and complex disorders. The ASA classification (American Society of Anesthesiologists, Physical Status Classification System) was applied and resulted in 15% = P2 (mild systemic disease, no functional limitation), 47% = P3 (severe systemic disease, definite functional limitations) and 38% = P4 (severe systemic disease, constant threat to life). Eighty-seven of the patients exhibited 3 or more chronic diseases with a prevalence of cardiovascular diseases, musculoskelettal disorders and dementia. Overall the differences between men and women were small, but broncho-pulmonary dieseases were significantly more frequent in women, while men were more often diagnosed with dementia and depression. Verbal communication was limited or not possible with 60% of the patients due to cognitive impairment or aphasia after a stroke. Although the objective treatment need is high, providing dentistry for frail and geriatric patients is characterized by risks due to poor general health conditions, difficulties in communication, limitations in feasibility and lack of adequate aftercare. In order to prevent the problem of undertreatment, elderly independently living

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  14. Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps)

    PubMed Central

    AlHabib, Khalid F.; Sulaiman, Kadhim; Al Suwaidi, Jassim; Almahmeed, Wael; Alsheikh-Ali, Alawi A.; Amin, Haitham; Al Jarallah, Mohammed; Alfaleh, Hussam F.; Panduranga, Prashanth; Hersi, Ahmad; Kashour, Tarek; Al Aseri, Zohair; Ullah, Anhar; Altaradi, Hani B.; Nur Asfina, Kazi; Welsh, Robert C.; Yusuf, Salim

    2016-01-01

    Background Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015. Results We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes. Conclusion Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities. PMID:26807577

  15. Isolation followed by integration: a model for development of a separate geriatric course.

    PubMed

    Wallace, Meredith; Lange, Jean; Grossman, Sheila

    2005-06-01

    Because of the growing population of older adults in America, nursing faculty throughout the United States have been consistently challenged during the past decade to use the most appropriate methods to strengthen geriatric content in baccalaureate nursing programs. The question of whether to integrate content throughout the curriculum or offer a stand-alone geriatric nursing course has been explored extensively, but no ultimate conclusion has been found. With the support of a grant for geriatric curriculum integration from the John A. Hartford Foundation, one university began the journey to integrate geriatric nursing curriculum throughout all baccalaureate nursing courses. However, at a curriculum evaluation meeting held halfway through the grant period, faculty expressed the need to have concentrated content earlier in the program that could serve as a foundation on which to build geriatric knowledge. Faculty unanimously voted to create a geriatric nursing course to be offered to students during their second year of baccalaureate study. PMID:16021801

  16. "Pedogeriatrics": a pediatric nephrologist's outlook on common challenges facing pediatric and geriatric nephrologists.

    PubMed

    Grünberg, Jose

    2010-03-01

    Dramatic demographic changes longevity and medical progress helped create a new population made up of the survivors of previously fatal diseases. These trends pose new major social and economic challenges that should be accounted for in health policy making. This paper discusses the similarities between the specialties of pediatrics and geriatrics, especially in the realm of patient care. Children and the elderly share a limited autonomy and dependence on the human environment (i.e., willing and able caregiving persons) due to age or disease. The long-term care of dependent patients (DP) requires caregiving persons who share with dependent persons the risk of losing autonomy, facing burnout, family disruption, and interference with work and educational activities. Families with DPs may face potential losses of income because both patients and caregivers are partially or completely unable to work, the former for medical reasons and the latter due to the new demands on their time and energy. Additionally, new expenses have to be met because while direct medical expenses might be covered by insurance or the State, other expenses have to be financed by the family, such as co-payments for medicines, new water or electricity home installations, and transport and eventual hotel costs if they have to stay overnight near a hospital outside of their town. The main objectives of long-term care should be to maximize patients' independence and prevent their physical and psychological deterioration while minimizing the social, economic and personal costs to caregivers. To achieve these goals, one needs a holistic approach, a multidisciplinary professional team (doctors, nurses, social workers, nutritionists and psychologists) and auxiliary staff (secretaries, electricians, administrators, messengers, cleaning staff, doormen, nursing aids and coordinators of medical appointments and medical procedures). Optimal management of DPs on chronic treatments such as chronic dialysis

  17. "Pedogeriatrics": a pediatric nephrologist's outlook on common challenges facing pediatric and geriatric nephrologists.

    PubMed

    Grünberg, Jose

    2010-03-01

    Dramatic demographic changes longevity and medical progress helped create a new population made up of the survivors of previously fatal diseases. These trends pose new major social and economic challenges that should be accounted for in health policy making. This paper discusses the similarities between the specialties of pediatrics and geriatrics, especially in the realm of patient care. Children and the elderly share a limited autonomy and dependence on the human environment (i.e., willing and able caregiving persons) due to age or disease. The long-term care of dependent patients (DP) requires caregiving persons who share with dependent persons the risk of losing autonomy, facing burnout, family disruption, and interference with work and educational activities. Families with DPs may face potential losses of income because both patients and caregivers are partially or completely unable to work, the former for medical reasons and the latter due to the new demands on their time and energy. Additionally, new expenses have to be met because while direct medical expenses might be covered by insurance or the State, other expenses have to be financed by the family, such as co-payments for medicines, new water or electricity home installations, and transport and eventual hotel costs if they have to stay overnight near a hospital outside of their town. The main objectives of long-term care should be to maximize patients' independence and prevent their physical and psychological deterioration while minimizing the social, economic and personal costs to caregivers. To achieve these goals, one needs a holistic approach, a multidisciplinary professional team (doctors, nurses, social workers, nutritionists and psychologists) and auxiliary staff (secretaries, electricians, administrators, messengers, cleaning staff, doormen, nursing aids and coordinators of medical appointments and medical procedures). Optimal management of DPs on chronic treatments such as chronic dialysis

  18. The level and focus of geriatric nursing content in ADN and BSN programs.

    PubMed

    Fullerton, J T; Lantz, J; Quayhagen, M P

    1992-11-01

    The didactic and clinical focus of geriatric curriculum content within both associate (ADN) and baccalaureate (BSN) schools of nursing in California was reviewed. Geriatric nursing content experts confirmed the detail of a geriatric nursing curriculum, then determined which of the content items were basic to both educational levels, and which might be appropriately deferred to programs of baccalaureate preparation. Nurse educators may use the results of this study to guide curriculum development in both depth and breadth of content.

  19. [Burn out of formal carers in geriatric facilities].

    PubMed

    Courty, Bénédicte; Bouisson, Jean; Compagnone, Philippe

    2004-09-01

    From a person-centered perspective, this study investigates the relationship between burn out and anxiety-depression, among geriatric caregivers, according to the helplessness-hopelessness theory. The population studied consists of 150 caregivers, drawn from different geriatric facilities throughout France. Data was collected from three self-administered questionnaires: the Maslach Burnout Inventory (MBI) measures burn out, whereas the STAI measures anxiety and the CES-D assesses symptoms of depression. These tools have been used to analyze the effects of several potential vulnerability factors. Three distinct groups have been identified by cluster analysis on the MBI's dimensions. Subjects from the first cluster (n = 88) did not suffer from burn out, whereas subjects from group 2 (n = 46) and group 3 (n = 16) have been rated "at risk" and "at high risk" of developing burn out. The three groups have significantly different levels of anxiety and depression. Age, profession and type of facility appeared as vulnerability factors for professional burn out.

  20. Passive therapeutic gardens. A study on an inpatient geriatric ward.

    PubMed

    Pachana, Nancy A; McWha, J Lindsay; Arathoon, Maureen

    2003-05-01

    A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed.

  1. Special considerations of antibiotic prescription in the geriatric population.

    PubMed

    Beckett, C L; Harbarth, S; Huttner, B

    2015-01-01

    Infectious diseases pose a major challenge in the elderly for two reasons: on the one hand the susceptibility to infection increases with age and when infections occur they often present atypically-on the other hand diagnostic uncertainty is much more pronounced in the geriatric population. Reconciling the opposing aspects of optimizing patient outcomes while avoiding antibiotic overuse requires significant expertise that can be provided by an infectious diseases consultant. In addition, geriatric facilities are reservoirs for multidrug-resistant organisms and other nosocomial pathogens, and infectious diseases consultants also play a vital role in assuring appropriate infection control measures. In this review we outline the challenges of diagnosis and management of infectious diseases in the elderly, and discuss the importance of appropriate antibiotic use in the elderly in order to demonstrate the value of the infectious diseases consultant in this special setting.

  2. Evaluation and Management of the Geriatric Urologic Oncology Patient

    PubMed Central

    McKibben, Maxim J.; Smith, Angela B.

    2014-01-01

    The geriatric population presents a unique set of challenges in urologic oncology. In addition to the known natural history of disease, providers must also consider patient factors such as functional and nutritional status, comorbidities and social support when determining the treatment plan. The development of frailty measures and biomarkers to estimate surgical risk shows promise, with several assessment tools predictive of surgical complications. Decreased dependence on chronologic age is important when assessing surgical fitness, as age cutoffs prevent appropriate treatment of many elderly patients who would benefit from surgery. Within bladder, kidney and prostate cancers, continued refinement of surgical techniques offers a broader array of options for the geriatric patient than previously available. PMID:25678987

  3. [Aspects for data mining implementation in gerontology and geriatrics].

    PubMed

    Mikhal'skiĭ, A I

    2014-01-01

    Current challenges facing theory and practice in ageing sciences need new methods of experimental data investigation. This is a result as of experimental basis developments in biological research, so of information technology progress. These achievements make it possible to use well proven in different fields of science and engineering data mining methods for tasks in gerontology and geriatrics. Some examples of data mining methods implementation in gerontology are presented.

  4. The Geriatric Resource Nurse Model: a culture change.

    PubMed

    Pfaff, Jann

    2002-01-01

    The introduction of the Geriatric Resource Nurse (GRN) Model and the Nurses Improving Care for Healthsystem Elders (NICHE) program has changed the culture at Waukesha Memorial Hospital. The number one key to successfully implementing them has been the overwhelming administrative and staff support. The following article contains an outline of the initial steps taken to implement the GRN model and a NICHE program, the way both became fully integrated into the culture of care, and evidence of positive patient and staff outcomes.

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

    PubMed

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

    2014-01-01

    The aging of the U.S. population continues to highlight emerging issues in providing care generally for older adults and specifically for older adults with cancer. The majority of patients with cancer in the U.S. are currently 65 years of age or older; therefore, training and research in geriatrics and geriatric oncology are viewed to be integral in meeting the needs of this vulnerable population. Yet, the ways to develop and integrate best geriatrics training within the context of hematology/oncology fellowship remain unclear. Toward this end, the current study seeks to evaluate the prior and current geriatric experiences and perspectives of hematology/oncology fellows. To gain insight into these experiences, focus groups of hematology/oncology fellows were conducted. Emergent themes included: 1) perceived lack of formal geriatric oncology didactics among fellows; 2) a considerable amount of variability exists in pre-fellowship geriatric experiences; 3) shared desire to participate in a geriatric oncology-based clinic; 4) differences across training levels in confidence in managing older adults with cancer; and 5) identification of specific criteria on how best to approach older adults with cancer in a particular clinical scenario. The present findings will help guide future studies in evaluating geriatrics among hematology/oncology fellows across institutions. They will also have implications in the development of geriatrics curricula and competencies specific to hematology/oncology training.

  6. When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative approach.

    PubMed

    Weber, Thomas; Strasser, Florian

    2015-12-01

    A 67-year-old patient with coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was scheduled for coronary artery bypass graft (CABG) surgery after a recent myocardial infarction despite a high perioperative risk of death. While waiting, acute renal failure developed, and the patient was admitted to the intensive care unit (ICU). After the patient and his wife were informed that CABG surgery was no longer possible, he declined further intensive care treatment and subsequently died peacefully.We show that a structured palliative approach which has been proposed for cancer patients may also be feasible in palliative situations concerning nononcologic patients. PMID:26620468

  7. Religion, Spirituality, and Health Status in Geriatric Outpatients

    PubMed Central

    Daaleman, Timothy P.; Perera, Subashan; Studenski, Stephanie A.

    2004-01-01

    BACKGROUND Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population. METHODS We performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12-item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. RESULTS In univariate analyses, physical functioning (P <.01), quality of life (P <.01), race (P <.01), depression (P <.01), age (P = .01), and spirituality (P <.01) were all associated with self-reported health status, but religiosity was not (P = .12). In a model adjusted for all covariates, however, spirituality remained independently associated with self-appraised good health (P = .01). CONCLUSIONS Geriatric outpatients who report greater spirituality, but not greater religiosity, are more likely to appraise their health as good. Spirituality may be an important explanatory factor of subjective health status in older adults. PMID:15053283

  8. Food intakes and preferences of hospitalised geriatric patients

    PubMed Central

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

    2002-01-01

    Background A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. Methods Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors affecting dietary adequacy were also investigated. Results The findings indicated that the mean intakes of energy and all nutrients investigated except for vitamin C and fluid were below the individual requirement for energy, protein and fluid, and the Malaysian Recommendation of Dietary Allowances (RDA) for calcium, iron, vitamin A, thiamin, riboflavin, niacin and acid ascorbic. In general, subjects preferred vegetables, fruits and beans to red meat, milk and dairy products. There was a trend of women to have a higher percentage for food wastage. Females, diabetic patients, subjects who did not take snacks and subjects who were taking hospital food only, were more likely to consume an inadequate diet (p < 0.05 for all values). Conclusions Food service system in hospital should consider the food preferences among geriatric patients in order to improve the nutrient intake. In addition, the preparation of food most likely to be rejected such as meat, milk and dairy products need some improvements to increase the acceptance of these foods among geriatric patients. This is important because these foods are good sources of energy, protein and micronutrients that can promote recovery from disease or illness. PMID:12165100

  9. Ofloxacin use in a geriatric population.

    PubMed

    Nicolle, L E; Degelau, J; Alessi, P; Cullison, J; Meyers, B

    1991-01-01

    The efficacy and safety of ofloxacin for the treatment of pneumonia, urinary infection and skin infections in the institutionalized elderly is being studied in a multicenter North American trial. The two study arms include an open, randomized, comparison of intravenous or oral ofloxacin with standard therapy in subjects requiring admission to acute care institutions, and an open study of oral ofloxacin in residents of chronic care facilities. To date 58 subjects have been enrolled with a mean age of 84 +/- 8 years. The preliminary observations from this ongoing multicenter study suggest that ofloxacin will be a safe and effective option for antimicrobial therapy in the treatment of these common infections in the institutionalized elderly.

  10. External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR).

    PubMed

    Mahan, Charles E; Liu, Yang; Turpie, A Graham; Vu, Jennifer T; Heddle, Nancy; Cook, Richard J; Dairkee, Undaleeb; Spyropoulos, Alex C

    2014-10-01

    Venous thromboembolic (VTE) risk assessment remains an important issue in hospitalised, acutely-ill medical patients, and several VTE risk assessment models (RAM) have been proposed. The purpose of this large retrospective cohort study was to externally validate the IMPROVE RAM using a large database of three acute care hospitals. We studied 41,486 hospitalisations (28,744 unique patients) with 1,240 VTE hospitalisations (1,135 unique patients) in the VTE cohort and 40,246 VTE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VTE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VTE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VTE was 0.20%; 95% confidence interval (CI) 0.18-0.22, 1.04%; 95%CI 0.88-1.25, and 4.15%; 95%CI 2.79-8.12 in the low, moderate, and high VTE risk groups, respectively, which compared to rates of 0.45%, 1.3%, and 4.74% in the three risk categories of the derivation cohort. For the derivation and validation cohorts, the total percentage of patients in low, moderate and high VTE risk occurred in 68.6% vs 63.3%, 24.8% vs 31.1%, and 6.5% vs 5.5%, respectively. Overall, the area under the receiver-operator characteristics curve for the validation cohort was 0.7731. In conclusion, the IMPROVE RAM can accurately identify medical patients at low, moderate, and high VTE risk. This will tailor future thromboprophylactic strategies in this population as well as identify particularly high VTE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.

  11. Medical implications of elder abuse: self-neglect.

    PubMed

    Reyes-Ortiz, Carlos A; Burnett, Jason; Flores, David V; Halphen, John M; Dyer, Carmel Bitondo

    2014-11-01

    Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment. State and federal policies are needed to address the pressing needs of this vulnerable population of seniors.

  12. Development of The Johns Hopkins University School of Nursing Adult/Geriatric Primary Care Nurse Practitioner Program in HIV Prevention, Treatment, and Care.

    PubMed

    Farley, Jason E; Stewart, Jennifer; Kub, Joan; Cumpsty-Fowler, Carolyn; Lowensen, Kelly; Becker, Kathleen

    2016-01-01

    In response to the call to create an AIDS Education and Training Center for Nurse Practitioner Education by the Health Resources and Services Administration, The Johns Hopkins University School of Nursing embarked on a transformative curriculum overhaul to integrate HIV prevention, treatment, and care into the Adult/Geriatric Nurse Practitioner Program. A six-step process outlined in the Curriculum Development for Medical Education was followed. A pilot cohort of Adult/Geriatric Nurse Practitioner students were enrolled, including 50% primary care setting and 50% HIV-focused primary care through a 12-month HIV continuity clinic experience. Through this pilot, substantive changes to the program were adopted. Programmatic outcomes were not compromised with the modification in clinical hours. The model of a 12-month HIV continuity clinical experience reduced the number of required preceptors. This model has important implications for the HIV workforce by demonstrating successful integration of HIV and primary care training for nurse practitioners.

  13. Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children.

    PubMed

    Bell, Iris R; Boyer, Nancy N

    2013-01-01

    The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to "first do no harm" in the early symptom management of otherwise uncomplicated AOM and URIs in children.

  14. Homeopathic Medications as Clinical Alternatives for Symptomatic Care of Acute Otitis Media and Upper Respiratory Infections in Children

    PubMed Central

    Boyer, Nancy N

    2013-01-01

    The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to “first do no harm” in the early symptom management of otherwise uncomplicated AOM and URIs in children. PMID:24381823

  15. Phenytoin blood concentrations in hospitalized geriatric patients: oral versus nasogastric feeding tube administration.

    PubMed

    Lubart, Emilia; Berkovitch, Matitiahu; Leibovitz, Arthur; Orly, Dafni; Segal, Refael

    2010-04-01

    Many medications administered to frail geriatric patients are not in a liquid form, but are crushed and dissolved in water before their administration through a nasogastric tube (NGT). Some medications are enteric coated and others are extended release. Only sparse information is available on their pharmacokinetics when administered through NGT. The aim of our study was to evaluate the pharmacokinetics of phenytoin administered through an NGT and to compare these with the pharmacokinetics of a group of patients receiving the drug orally. Twenty patients were studied in a stable clinical condition, from the long-term care ward of the Geriatric Medical Center Shmuel Harofeh. They were consistently treated with phenytoin for the prevention of seizure disorders. Patients in group 1 (n = 12) had oropharyngeal dysphagia and received feeding and medications by NGT. Group 2 (n = 8), included age-matched orally fed patients from the same department, who received phenytoin orally. Blood samples for phenytoin concentration were taken at baseline, time 0, and at 1, 3, 4, 6, and 8 hours postdrug administration; phenytoin was measured using the AxSYM assay. The mean daily dose was not statistically different between the 2 groups: 291 +/- 28 (200-300) mg/d and 300 +/- 53 (200-400) mg/d, in the NGT, and the orally fed group, respectively, in one dose. Pharmacokinetic parameters of phenytoin were not significantly different between the 2 groups; trough concentrations, 1.9 +/- 1.7 (0.5-4.9) versus 2.2 +/- 1.8 (1.0-6.5) microg/mL; Cmax, 6.6 +/- 3.4 (2.5-9.1) versus 7.3 +/- 6.7 (2.7-8.4) microg/mL; tmax, 5.1 +/- 3.1 (3.1-8.2) versus 4.6 +/- 2.7 (2.3-8.4) hours; area under the curve, 52.2 +/- 40.1 (41.1-61.2) versus 62.3 +/- 84.7 (30.2-77.2) microg/h/mL, in the NGT fed versus the oral fed, respectively. Phenytoin pharmacokinetic parameters are not significantly different between patients receiving the drug through NGT as compared with those who received it orally, but the implication

  16. Ultrasound-Guided Regional Anesthesia in a Glucose-6-Phosphate Dehydrogenase (G6PD)-Deficient Geriatric Trauma Patient

    PubMed Central

    Födinger, Agnes M.; Kammerlander, Christian; Luger, Thomas J.

    2012-01-01

    Objective: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder causing hemolytic anemia. Exposure to drugs is considered to be the most common cause of acute hemolysis in patients with G6PD deficiency. Experience with regional anesthesia, in particular peripheral nerve blocks, is rarely described in patients with G6PD deficiency, but is of great clinical interest. For this reason, we now report on the successful management of ultrasound-guided axillary brachial plexus block in a patient with geriatric G6PD deficiency. Case report: A female, 75-year-old geriatric trauma patient with G6PD deficiency and a fracture of the left forearm, was scheduled for osteosynthesis of the left forearm. For surgery regional anesthesia with ultrasound-guided axillary brachial plexus block with 30 mL bupivacaine 0.5% was established. Surgical operation und postoperative course were uneventful and with no signs of hemolysis. Conclusion: Ultrasound-guided axillary brachial plexus block with bupivacaine was a safe and effective technique in this patient with G6PD deficiency. Peripheral nerve block is a major analgesic approach and of great value for anesthesiologists and surgeons, especially in our aging and multimorbid society. PMID:23569708

  17. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness

    PubMed Central

    Joshi, Roshni; Myles, Puja R.

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52–0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55–0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  18. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness.

    PubMed

    Joshi, Roshni; Venkatesan, Sudhir; Myles, Puja R

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52-0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55-0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

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

    PubMed Central

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

    2016-01-01

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

  20. Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

    PubMed Central

    Lee, David C; Gupta, Vibha K; Carr, Brendan G; Malik, Sidrah; Ferguson, Brandy; Wall, Stephen P; Smith, Silas W; Goldfrank, Lewis R

    2016-01-01

    Objective To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. Research design and methods Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. Results In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. Conclusions We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks. PMID:27547418

  1. Diagnosis and management of acute kidney injury: deficiencies in the knowledge base of non-specialist, trainee medical staff.

    PubMed

    Muniraju, T M; Lillicrap, M H; Horrocks, J L; Fisher, J M; Clark, R M W; Kanagasundaram, N S

    2012-06-01

    Enhanced education has been recommended to improve non-specialist management of acute kidney injury (AKI). However, the extent of any gaps in knowledge has yet to be defined fully. The aim of this study was to assess understanding of trainee doctors in the prevention, diagnosis and initial management of AKI. An anonymised questionnaire was completed by hospital-based trainees across Newcastle Renal Unit's catchment area. Responses were evaluated against a panel of pre-defined ideal answers. The median score was 9.5 out of 20 (n = 146; range 0-17) and was lower in more junior trainees. Fifty percent of trainees could not define AKI, 30% could not name more than two risk factors for AKI and 37% could not name even one indication for renal referral. These serious gaps in knowledge highlight the need for enhanced education aimed at all training grades. Organisational changes may also be required to optimise patient safety.

  2. Chiropractic and geriatrics: a review of the training, role, and scope of chiropractic in caring for aging patients.

    PubMed

    Killinger, Lisa Zaynab

    2004-05-01

    Chiropractors may be well-positioned to play an important role in health promotion, injury and disease prevention, and on geriatric care teams, due to their practice style and holistic philosophy. The bottom line in aging care is that someone in the health-care world must provide health promotion and preventive services to older patients before the wave of aged patients profoundly overwhelms our health-care system. Chiropractic services are safe and relatively low-cost, and patient satisfaction with them is very high. In the managed-care environment, time pressures on allopathic providers may preclude them from spending sufficient time discussing health promotion and illness prevention with their patients. Chiropractic, when paid for out-of-pocket, is not as affected by these extreme pressures. With the hands-on nature of chiropractic care, a strong doctor-patient relationship is forged in which health and lifestyle recommendations may be comfortably and effectively discussed. Relative to musculoskeletal care in elderly patients, chiropractic adjustments (spinal manipulative therapy) are recommended by the Agency for Health Care Policy and Research for the care of acute low back pain, and the American Geriatric Society Panel Guidelines for the Management of Chronic Pain state that non-pharmaceutical interventions such as chiropractic may be appropriate. Most geriatric health-care providers have a limited number of options to offer patients with these complaints. Various lower-force chiropractic techniques are available as safe alternatives to drugs and surgery for musculoskeletal complaints in the older patient. Due to the prevalence of these conditions in older patients, and the success of chiropractic in caring for these patients, interdisciplinary geriatric health care teams should include the doctor of chiropractic. Chiropractors, well trained in health assessment, diagnosis, radiographic studies, health promotion, and illness prevention, are well-positioned to

  3. Plasma suPAR levels are associated with mortality, admission time, and Charlson Comorbidity Index in the acutely admitted medical patient: a prospective observational study

    PubMed Central

    2012-01-01

    Introduction Soluble urokinase plasminogen activator receptor (suPAR) is the soluble form of the membrane-bound receptor (uPAR) expressed predominantly on various immune cells. Elevated plasma suPAR concentration is associated with increased mortality in various patient groups, and it is speculated that suPAR is a low-grade inflammation marker reflecting on disease severity. The aim of this prospective observational study was to determine if the plasma concentration of suPAR is associated with admission time, re-admission, disease severity/Charlson Comorbidity Index Score, and mortality. Methods We included 543 patients with various diseases from a Danish Acute Medical Unit during a two month period. A triage unit ensured that only medical patients were admitted to the Acute Medical Unit. SuPAR was measured on plasma samples drawn upon admission. Patients were followed-up for three months after inclusion by their unique civil registry number and using Danish registries to determine admission times, readmissions, International Classification of Diseases, 10th Edition (ICD-10) diagnoses, and mortality. Statistical analysis was used to determine suPAR's association with these endpoints. Results Increased suPAR was significantly associated with 90-day mortality (4.87 ng/ml in survivors versus 7.29 ng/ml in non-survivors, P < 0.0001), higher Charlson Score (P < 0.0001), and longer admission time (P < 0.0001), but not with readmissions. The association with mortality remained when adjusting for age, sex, C-reactive protein (CRP), and Charlson Score. Furthermore, among the various Charlson Score disease groups, suPAR was significantly higher in those with diabetes, cancer, cardiovascular disease, and liver disease compared to those without comorbidities. Conclusions SuPAR is a marker of disease severity, admission time, and risk of mortality in a heterogeneous cohort of patients with a variety of diseases. The independent value of suPAR suggests it could be of value in

  4. Multifaceted Intervention to Prevent Venous Thromboembolism in Patients Hospitalized for Acute Medical Illness: A Multicenter Cluster-Randomized Trial

    PubMed Central

    Roy, Pierre-Marie; Rachas, Antoine; Meyer, Guy; Le Gal, Grégoire; Durieux, Pierre; El Kouri, Dominique; Honnart, Didier; Schmidt, Jeannot; Legall, Catherine; Hausfater, Pierre; Chrétien, Jean-Marie; Mottier, Dominique

    2016-01-01

    Background Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients. Objectives To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders) for the prevention of venous thromboembolism. Patients/Methods Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13) or control (n = 14). All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control) and 15,351 (8,359 intervention and 6,992 control) in the pre-intervention and intervention periods, respectively. Results Symptomatic venous thromboembolism or major bleeding (primary outcome) occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78–1.34]). The rates of thromboembolism (1.9% vs. 1.9%), major bleedings (1.2% vs. 1.3%), and mortality (11.3% vs. 11.1%) did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2%) than the control (40.7% to 44.1%: +3.4%), while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%). Conclusions Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients. Trial Registration ClinicalTrials.gov NCT01212393 PMID:27227406

  5. Medicine of senescence or managing a hospital system: the resistible rise of geriatric medicine in the State of Victoria.

    PubMed

    Hunter, Cecily

    2006-04-01

    This paper investigates the conditions in which geriatric medicine emerged in the state of Victoria between the late 1950s and the late 1970s. It shows how, in transforming a charity model of care into a medical model of service, nascent geriatricians were caught up in the shifting balance of responsibilities between state and Commonwealth governments in funding health services and care for the aged, and in the efforts of a small segment of the Australian medical profession to establish an organisational setting and professional context for social medicine. In Victoria, the potential for doctors to circumvent bureaucratic and professional limitations on their work lay in their relationship with their institutional committees of management whose members were drawn from the general community. The paper argues that pioneer 'geriatricians' failed to establish a field of practice that met all the needs they discerned in their patient group because they could not change community ideas about appropriate responses to old age infirmity.

  6. How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes toward Geriatric Care

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.

    2009-01-01

    Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the…

  7. Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

    ERIC Educational Resources Information Center

    Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea

    2012-01-01

    The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…

  8. The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

    ERIC Educational Resources Information Center

    Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  10. Mortality of Geriatric and Younger Patients with Schizophrenia in the Community

    ERIC Educational Resources Information Center

    Ran, Mao-Sheng; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Li, Li; Li, Si-Gan; Mao, Wen-Jun; Hu, Shi-Hui; Schwab, Gerhard; Conwell, Yeates

    2008-01-01

    Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age greater than or equal to 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a…

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

    PubMed

    Natali, Jean-Philippe; Schwald, Nathalie; Bach, Frédérique; Bourgouin, Gaëlle; Chiffray, Dominique; Bloch, Frédéric

    2015-01-01

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

  12. 75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... program advances in palliative care, and performance and oversight of the VA Geriatric Research, Education... gerontology. The Committee assesses the capability of VA health care facilities and programs to meet the... discussions on VA's geriatrics and extended care programs, aging research activities, update on VA's...

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  14. An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

    ERIC Educational Resources Information Center

    Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping

    2013-01-01

    A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized…

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

    ERIC Educational Resources Information Center

    Woolsey, Lisa J.

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

  17. Impairment in Instrumental Activities of Daily Living and the Geriatric Syndrome of Self-Neglect

    ERIC Educational Resources Information Center

    Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.

    2008-01-01

    Purpose: We sought to characterize self-neglect definitively as a geriatric syndrome by identifying an association with functional impairment. Design and Methods: We performed a cross-sectional home evaluation of 100 community-living older adults referred by Adult Protective Services for geriatric self-neglect and 100 matched adults from a…

  18. Preventable mortality in geriatric hip fracture inpatients

    PubMed Central

    Tarrant, S. M.; Hardy, B. M.; Byth, P. L.; Brown, T. L.; Attia, J.; Balogh, Z. J.

    2014-01-01

    There is a high rate of mortality in elderly patients who sustain a fracture of the hip. We aimed to determine the rate of preventable mortality and errors during the management of these patients. A 12 month prospective study was performed on patients aged > 65 years who had sustained a fracture of the hip. This was conducted at a Level 1 Trauma Centre with no orthogeriatric service. A multidisciplinary review of the medical records by four specialists was performed to analyse errors of management and elements of preventable mortality. During 2011, there were 437 patients aged > 65 years admitted with a fracture of the hip (85 years (66 to 99)) and 20 died while in hospital (86.3 years (67 to 96)). A total of 152 errors were identified in the 80 individual reviews of the 20 deaths. A total of 99 errors (65%) were thought to have at least a moderate effect on death; 45 reviews considering death (57%) were thought to have potentially been preventable. Agreement between the panel of reviewers on the preventability of death was fair. A larger-scale assessment of preventable mortality in elderly patients who sustain a fracture of the hip is required. Multidisciplinary review panels could be considered as part of the quality assurance process in the management of these patients. Cite this article: Bone Joint J 2014;96-B:1178–84. PMID:25183587

  19. [Vitamin B12 deficiency in geriatrics].

    PubMed

    Bopp-Kistler, I; Rüegger-Frey, B; Grob, D; Six, P

    1999-11-01

    Cobalamin deficiency increases with advancing age. The cut-off point of serum concentration should be raised, because many elderly people with "normal" serum vitamin B12 concentrations are metabolically deficient in cobalamin. The measurement of the metabolites homocysteine and/or methylmalonic acid is recommended. Cobalamin deficiency may result in a variety of atypical symptoms. Hematological changes typical of megaloblastic anemia are absent in a majority of patients with neuropsychiatric disorders. Generally underlying pernicious anemia is not the main cause of cobalamin deficiency in the elderly. Protein-bound cobalamin malabsorption due to atrophic gastritis with hypo- or achlorhydria is a common cause of cobalamin deficiency in elderly people. An important manifestation of cobalamin deficiency is cognitive impairment. Much controversy exists on the subject of the association of dementia of the Alzheimer type with cobalamin deficiency. In several studies dementia has been related to low serum cobalamin levels. Physicians should be liberal of cobalamin therapy. The window of opportunity for effective intervention may be as short as one year from the onset of medical symptoms. At last a compilation of recommendations is given.

  20. Assessment of the geriatric competence and perceived needs of Italian nephrologists: an internet survey.

    PubMed

    Aucella, Filippo; Brunori, Giuliano; Dalmartello, Michela; Leosco, Dario; Paolisso, Giuseppe; Marangella, Martino; Capasso, Giovanni Battista; Antonelli Incalzi, Raffaele

    2016-06-01

    An internet survey was set up to assess the geriatric competence and perceived needs of 337 members of the Italian society of nephrology (SIN). The survey assessed how well aware nephrologists are of the typical geriatric conditions and needs of their elderly chronic kidney disease (CKD) patients. SIN associates were also questioned about their current use of comprehensive geriatric assessment, prescription of potentially nephrotoxic drugs, and screening for osteoporosis. The main finding is that CKD and dialysis are almost unanimously perceived as typically geriatric conditions, but knowledge and use of geriatric tools are scanty. While use of potentially inappropriate drugs is rare, almost half of the patients are not screened for osteoporosis. The significant clinical gaps observed could greatly impair the management of older CKD patients, and call for an urgent educational intervention. PMID:26385799

  1. Arterial blood pressure measurement in a population of healthy geriatric dogs.

    PubMed

    Meurs, K M; Miller, M W; Slater, M R; Glaze, K

    2000-01-01

    The purpose of this study was to evaluate healthy geriatric dogs for the presence of systemic hypertension. Thirty-three geriatric dogs (i.e., dogs exceeding the geriatric age range for their weight group) and 22 control dogs (i.e., dogs less than six years of age) were evaluated by measuring blood pressure with an oscillometric monitor. Five consecutive blood pressure measurements were taken in each dog, averaged, and compared. Diastolic and mean blood pressure measurements were significantly lower in the geriatric group as compared to the control group. Systolic blood pressure measurements were not significantly different between the two groups. Systemic hypertension does not appear to be a common clinical problem in the healthy geriatric dog.

  2. Hospital to home: a geriatric educational program on effective discharge planning.

    PubMed

    DeCaporale-Ryan, Lauren N; Cornell, Ann; McCann, Robert M; McCormick, Kevin; Speice, Jenny

    2014-01-01

    There has been increased attention on the needs of the burgeoning older adult population, with focus on the limited education and training experiences available in geriatric care. Older adults transitioning between levels of care often require increased attention, and the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has encouraged greater training opportunities be provided to better understand the needs of this population. The Hospital to Home Program is one model of geriatric training emphasizing many of the AGS recommendations. Through qualitative analyses of 51 internal medicine residents' reflections, the authors report how this educational program is meeting the above need and share how Hospital to Home is enhancing residents' skills in creating a safe discharge for geriatric patients and their families.

  3. Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research

    PubMed Central

    Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G.; Williams, Grant R.; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L.; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M.; Hurria, Arti

    2016-01-01

    Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. “GA with management” is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, “Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer,” a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915

  4. Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort.

    PubMed

    Kyrozis, A; Psaltopoulou, T; Stathopoulos, P; Trichopoulos, D; Vassilopoulos, D; Trichopoulou, A

    2009-05-01

    In a prospective epidemiological investigation aiming to identify dietary lipids potentially associated with affective state and depression, 610 healthy men and women aged 60 years or older, participating in the EPIC-Greece cohort and residing in the Attika region had dietary, sociodemographic, anthropometric, medical and lifestyle variables ascertained at enrollment. Six to 13 years later, affective state was evaluated through the 15-point geriatric depression scale (GDS) score along with cognitive function and medical variables. In multivariate linear regression analysis, while adjusting for potential confounders, GDS score was negatively associated with dietary intake of monounsaturated lipids (MUFA) and their main source, olive oil, and positively associated with intake of polyunsaturated lipids (PUFA) and one of their principal sources, seed oils. Intake of calories, total lipids, fish and seafood or saturated lipids did not exhibit significant association with GDS. Potential non-linearities were assessed by quantile multivariate regression analysis: The median GDS score was positively associated with PUFA and seed oils intake, while other lipid groups showed no appreciable associations. The 90th percentile of the GDS score (towards the high end) exhibited significant negative associations with MUFA and olive oil, weaker positive associations with PUFA and seed oils and no appreciable association with other lipid group dietary intakes. We conclude that among Attika elders, lower intake of seed oils and higher intake of olive oil prospectively predict a healthier affective state. Olive oil intake, in particular, predicts a lower chance of scoring in the highest part of the GDS. PMID:18952225

  5. Geriatric screening in first opinion practice – results from 45 dogs

    PubMed Central

    Davies, M

    2012-01-01

    Objectives To evaluate and report the results of screening geriatric dogs in a first opinion practice. Methods A prospective health screen of dogs over nine-years-old involving history taking, physical examination and urinalysis. Results At least one previously unrecognised problem was identified in 80% of 45 dogs and 353 findings (mean 7·8 per dog) were recorded. Owners often failed to recognise and report serious signs of age-related disease. However, they most often reported increased sleeping (31%), loss of hearing (29%) or sight (20%), stiffness or lameness (22%) and “slowing down” (20%). Increased lens opacity (64%), increased thirst (58%), pain (24%), increased frequency of urination (24%), signs of osteoarthritis (24%) and dental disease (22%) were most frequently identified at the time of consultation. Potentially, life-threatening findings included respiratory distress, palpable abdominal masses and metastatic lung disease. Screening resulted in 29 further diagnostic procedures, including 10 dental procedures, seven medical treatments, two surgical procedures and euthanasia of two dogs. Clinical Significance Screening elderly dogs identified unrecognised and unreported health risk factors resulting in lifestyle modification and ongoing monitoring, as well as signs of age-related diseases resulting in diagnostic investigations, early diagnoses and surgical and medical interventions to improve quality of life. PMID:22835038

  6. Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort.

    PubMed

    Kyrozis, A; Psaltopoulou, T; Stathopoulos, P; Trichopoulos, D; Vassilopoulos, D; Trichopoulou, A

    2009-05-01

    In a prospective epidemiological investigation aiming to identify dietary lipids potentially associated with affective state and depression, 610 healthy men and women aged 60 years or older, participating in the EPIC-Greece cohort and residing in the Attika region had dietary, sociodemographic, anthropometric, medical and lifestyle variables ascertained at enrollment. Six to 13 years later, affective state was evaluated through the 15-point geriatric depression scale (GDS) score along with cognitive function and medical variables. In multivariate linear regression analysis, while adjusting for potential confounders, GDS score was negatively associated with dietary intake of monounsaturated lipids (MUFA) and their main source, olive oil, and positively associated with intake of polyunsaturated lipids (PUFA) and one of their principal sources, seed oils. Intake of calories, total lipids, fish and seafood or saturated lipids did not exhibit significant association with GDS. Potential non-linearities were assessed by quantile multivariate regression analysis: The median GDS score was positively associated with PUFA and seed oils intake, while other lipid groups showed no appreciable associations. The 90th percentile of the GDS score (towards the high end) exhibited significant negative associations with MUFA and olive oil, weaker positive associations with PUFA and seed oils and no appreciable association with other lipid group dietary intakes. We conclude that among Attika elders, lower intake of seed oils and higher intake of olive oil prospectively predict a healthier affective state. Olive oil intake, in particular, predicts a lower chance of scoring in the highest part of the GDS.

  7. The Effects of Donepezil on 15-Item Geriatric Depression Scale Structure in Patients with Alzheimer Disease

    PubMed Central

    Yang, Youngsoon; Kwak, Yong Tae

    2016-01-01

    Background/Aims In Alzheimer disease (AD), depression is among the most common accompanying neuropsychiatric symptoms and has different clinical manifestations when compared with early-life depression. In patients with drug-naïve AD, we tried to explore the structure of the 15-item Geriatric Depression Scale (GDS15) and the effect of donepezil on these substructures. Methods GDS15, cognitive function, and activities of daily living function tests were administered to 412 patients with probable AD who had not been medicated before visiting the hospital. Using principal component analysis, three factors were identified. The patients with AD who received only donepezil were retrospectively analyzed and we compared the change of cognition and GDS15 subgroup after donepezil medication. Results Our study identified three factors and revealed that the GDS15 may be comprised of a heterogeneous scale. The Barthel index was significantly correlated with factor 1 (positively) and factor 2 (negatively). The Korean version of the MMSE (K-MMSE) was significantly correlated with factor 2 and factor 3. Compared to the baseline state, K-MMSE and GDS15 showed significant improvement after taking donepezil. Among GDS15 subgroups, factor 2 and factor 3 showed significant improvement after donepezil treatment. Conclusions These results suggest that the GDS15 may be comprised of a heterogeneous scale and donepezil differentially affects the GDS15 subgroup in AD. PMID:27790242

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

    PubMed

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

    2016-07-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

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

    PubMed

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

    2016-07-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

  10. Conducting a study of Internet-based video conferencing for assessing acute medical problems in a nursing facility.

    PubMed Central

    Weiner, Michael; Schadow, Gunther; Lindbergh, Donald; Warvel, Jill; Abernathy, Greg; Perkins, Susan M.; Dexter, Paul R.; McDonald, Clement J.

    2002-01-01

    We expect the use of real-time, interactive video conferencing to grow, due to more affordable technology and new health policies. Building and implementing portable systems to enable conferencing between physicians and patients requires durable equipment, committed staff, reliable service, and adequate protection and capture of data. We are studying the use of Internet-based conferencing between on-call physicians and patients residing in a nursing facility. We describe the challenges we experienced in constructing the study. Initiating and orchestrating unscheduled conferences needs to be easy, and requirements for training staff in using equipment should be minimal. Studies of health outcomes should include identification of medical conditions most amenable to benefit from conferencing, and outcomes should include positive as well as negative effects. PMID:12463950

  11. Impact of regional pre-hospital emergency medical services in treatment of patients with acute ischemic stroke.

    PubMed

    Sozener, Cemal B; Barsan, William G

    2012-09-01

    Stroke is a major public health concern afflicting an estimated 795,000 Americans annually. The associated morbidity and mortality is staggering. Early treatment with thrombolytics is beneficial. The window for treatment is narrow and minimization of the time from symptom onset to treatment is vital. The general population is not well informed as to the warning signs or symptoms of stroke, leading to substantial delays in emergency medical services (EMS) activation. Ambulance transport of stroke patients to the hospital has demonstrated improvements in key benchmarks such as door to physician evaluation, door to CT initiation, and increased thrombolytic treatment. Pre-hospital notification of the impending arrival of a stroke patient allows for vital preparation in the treating emergency department, and improving timely evaluation and treatment upon arrival of the stroke patient. EMS systems are a vital component of the management of stroke patients, and resources used to improve these systems are beneficial. PMID:22994221

  12. Information resources to aid parental decision-making on when to seek medical care for their acutely sick child: a narrative systematic review

    PubMed Central

    Neill, Sarah; Roland, Damian; Jones, Caroline HD; Thompson, Matthew; Lakhanpaul, Monica

    2015-01-01

    Objective To identify the effectiveness of information resources to help parents decide when to seek medical care for an acutely sick child under 5 years of age, including the identification of factors influencing effectiveness, by systematically reviewing the literature. Methods 5 databases and 5 websites were systematically searched using a combination of terms on children, parents, education, acute childhood illness. A narrative approach, assessing quality via the Mixed Methods Appraisal Tool, was used due to non-comparable research designs. Results 22 studies met the inclusion criteria: 9 randomised control trials, 8 non-randomised intervention studies, 2 qualitative descriptive studies, 2 qualitative studies and 1 mixed method study. Consultation frequency (15 studies), knowledge (9 studies), anxiety/reassurance (7 studies), confidence (4 studies) satisfaction (4 studies) and antibiotic prescription (4 studies) were used as measures of effectiveness. Quality of the studies was variable but themes supported information needing to be relevant and comprehensive to enable parents to manage an episode of minor illness Interventions addressing a range of symptoms along with assessment and management of childhood illness, appeared to have the greatest impact on the reported measures. The majority of interventions had limited impact on consultation frequencies, No conclusive evidence can be drawn from studies measuring other outcomes. Conclusions Findings confirm that information needs to be relevant and comprehensive to enable parents to manage an episode of minor illness. Incomplete information leaves parents still needing to seek help and irrelevant information appears to reduce parents’ trust in the intervention. Interventions are more likely to be effective if they are also delivered in non-stressful environments such as the home and are coproduced with parents. PMID:26674495

  13. [Acute alcohol intoxication among children and adolescents admitted to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice during 2000-2010--preliminary study].

    PubMed

    Kamińska, Halla; Agnieszka, Zachurzok-Buczyńska; Gawlik, Aneta; Małecka-Tendera, Ewa

    2012-01-01

    The alcohol drinking at the young age is a risk factor of alcohol addiction later in life, and is connected with school problems, binge drinking, tobacco addiction, illegal drug use, violence, crime commitment, and risky sexual behaviors. Alcohol drinking in the last 12 months is declared by 78% Polish children. The aim of the study was to evaluate the frequency of admissions due to alcohol intoxication to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Pediatric Center of Silesia and the identification of the risk factors of the acute alcohol intoxication among Polish children and adolescents. Ten-year retrospective study includes investigation of patients medical records from the Department of Pediatrics. Among 8048 patients hospitalized in the Department of Pediatrics between the years 2000-2010, 220 (2.7%) cases of acute alcohol poisoning occurred The detailed data analysis from 139 patients [66 (47.5%) girls, 73 (52,5%) boys] was done. In the years 2006-2010 the number of girls admitted to the department increased in comparison to boys. The largest group of patients was at age between 14 and 16 years [61 (44%) children]. The blood alcohol concentration at the moment of admission to the hospital was 0.1 to 4.0 per thousand. In most cases (92.8%) the alcohol intoxication was intentional. Five percent of them were suicide attempts. In the youngest group of children alcohol abuse was unintentional. 23 (16.5%) of patients initially needed admission to the intensive care unit. In 30 (21.6%) patient the family was incomplete and five times more often father was absent. The alcohol addiction occurs in 18 (13.0%) fathers and 10 (7.2%) mothers of our patients. It is concluded that over the last decade the number of girls admitted due to alcohol abuse increased. Children at school grade between 7-9 are intoxicated most often. One six of intoxicated patents needed hospitalization at intensive care unit.

  14. Time Interval from Symptom Onset to Hospital Care in Patients with Acute Heart Failure: A Report from the Tokyo Cardiac Care Unit Network Emergency Medical Service Database

    PubMed Central

    Shiraishi, Yasuyuki; Kohsaka, Shun; Harada, Kazumasa; Sakai, Tetsuro; Takagi, Atsutoshi; Miyamoto, Takamichi; Iida, Kiyoshi; Tanimoto, Shuzou; Fukuda, Keiichi; Nagao, Ken; Sato, Naoki; Takayama, Morimasa

    2015-01-01

    Aims There seems to be two distinct patterns in the presentation of acute heart failure (AHF) patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear. Methods The Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH) time for those patients (2h); early- (presenting ≤2h after symptom onset) vs. gradual-onset (late) group (>2h). The primary outcome was in-hospital mortality. Results The early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP), respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001); whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001) and atrial fibrillation (30.0% vs. 26.0%; P<0.001) were more frequently seen in the late OH group. Overall, 242 (6.5%) patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51−0.99; P = 0.043). Conclusions Early-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion) but had a better in-hospital outcome compared to gradual-onset patients. PMID:26562780

  15. Geriatric depression assessment by rural primary care physicians

    PubMed Central

    Glasser, M; Vogels, L; Gravdal, J

    2013-01-01

    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

  16. Interdisciplinary collaboration in geriatrics: advancing health for older adults.

    PubMed

    Young, Heather M; Siegel, Elena O; McCormick, Wayne C; Fulmer, Terry; Harootyan, Linda K; Dorr, David A

    2011-01-01

    The call for interdisciplinary research, education, and practice is heightened by the recognition of the potential it holds in generating creative solutions to complex problems in health care and to improving quality and effectiveness of care. With the aging of the population and the complex issues in caring for older adults, interdisciplinary collaboration is particularly salient to the field of geriatrics. However, despite interest in this approach for several decades, adoption has been slow and dissemination is not widespread. This article provides examples of recent initiatives and presents driving and restraining forces involved in adoption of interdisciplinary approaches. PMID:21757083

  17. Separating mood disturbance from mild cognitive impairment in geriatric depression.

    PubMed

    Steffens, David C

    2008-08-01

    Disentangling depression from dementia remains one of the most difficult clinical challenges for psychiatrists caring for older adults. The relationship between geriatric depression and dementia is complex for several reasons. First, cognitive impairment is often a prominent feature of depression in the elderly. Cognition may improve with successful treatment of depression but it may not normalize. Indeed, marked memory impairment in older depressed individuals may indicate a prodromal state of dementia. This review will examine issues related to depression and cognitive disorder in the elderly. The author will provide an evidence-based approach to separate mood disorder from cognitive disorder among older adults.

  18. Innovative model of interprofessional geriatric consultation: specialized seniors clinics.

    PubMed

    Kadowaki, Laura; Chow, Helen; Metcalfe, Sarah; Friesen, Kathleen

    2014-01-01

    As the Canadian population ages, healthcare systems have become increasingly interested in exploring new ways to deliver services to frail older adults, and in particular older adults with dementia. The Specialized Seniors Clinics (SSCs) are an innovative integrated network of six outpatient clinics in BC's Fraser Health Authority that utilize interprofessional teams to provide comprehensive geriatric assessments and care planning for frail older adults. The SSCs provided approximately 19,000 appointments in the past fiscal year, and clients and primary care physicians are highly satisfied with the model. This article describes the SSC model and provides reflection on the model development, implementation and standardization processes. PMID:25591611

  19. Absence of Streptococcus pneumoniae in pharyngeal swabs of geriatric inpatients.

    PubMed

    Jomrich, Nina; Kellner, Silvia; Djukic, Marija; Eiffert, Helmut; Nau, Roland

    2015-07-01

    Colonization of the pharynx by Streptococcus pneumoniae was studied in 185 in-hospital geriatric patients (median age 81 years) from 29 March 2011 to 22 June 2011. Swabs were plated on blood agar plates. Colonies with a morphology suggesting S. pneumoniae were further analyzed. Surprisingly, pneumococci were not found in any of the samples. Pneumococci chronically colonizing the pharynx of elderly people may be much rarer than previously thought and probably are not the source of pneumococcal pneumonia in old age. PMID:25746605

  20. Cultural perspectives of meals expressed by patients in geriatric care.

    PubMed

    Sidenvall, B; Fjellström, C; Ek, A C

    1996-04-01

    The aim of this study was to investigate cultural values and ideas concerning table manners and food habits expressed by patients in geriatric care. The research approach was ethnographic. The findings exposed conflicts related to three themes. The first, "Mind your manners", demonstrated problems in managing food and objects, keeping clean, and conduct at table. The second, "Appetite for food", was connected to tradition and taste, healthy food and the need not to waste food. The third, "Be contented and do not complain", illustrated the elderly patients' socialized manners in talking about meals and food.

  1. [Regional anesthesia in geriatric surgery. Possibilities and limitations: (author's transl)].

    PubMed

    Sehhati, G; Sarvestani, M

    1976-10-01

    Modern anesthetic techniques are superior to regional anesthesia for most operative procedures. Yet because of new advances in techniques and methods and sound pathophysiological knowledge, there are some operations for which regional anesthesia has distinct advantages over general anesthesia. This is the case, for example, in geriatric surgery. Here, the technical simplicity and short amount of time required give spinal anesthesia marked advantages over general anesthesia. Post-spinal headaches and slight falls in blood pressure have become rarer due to technical innovations and can reasonably be accepted. PMID:825724

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

    PubMed

    Blazer, Dan G; Wallace, Robert B

    2016-09-01

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

  3. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

    PubMed Central

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

    2016-01-01

    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  4. Comprehensive geriatric assessment of effects of hospitalization and long-term rehabilitation of patients following lower extremity arthroplasty

    PubMed Central

    Sonoda, Yuma; Sawano, Shinichiro; Kojima, Yuka; Kugo, Masato; Taniguchi, Masashi; Maegawa, Shoji; Kawasaki, Taku

    2016-01-01

    [Purpose] This study was performed to examine the effects of subacute physical therapy (PT) on activities of daily living (ADL), quality of life, and geriatric aspects of patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA). [Subjects] The subjects were TKA (n=56) and THA (n=39) patients who received PT on the first day of independent ADL (up to 2 weeks) and just prior to discharge (4 weeks). [Methods] The functional independence measure (FIM), grip strength, knee extension strength (KES), timed up and go (TUG) test, mini-mental state examination (MMSE), geriatric depression scale short form (GDS-15), fall efficacy scale (FES), and medical outcome study 8-item short-form health survey (SF-8) were used as outcome measure, and comorbidity involvement was also investigated. [Results] Improvements in FIM, KES, TUG, GDS-15, FES, and SF-8 scores were seen in both groups (effect size, 0.31–0.87). Poor PT effects were found for THA patients aged ≥65 years, for TKA and THA patients with an MMSE score ≤28, and for THA patients with two or more comorbidities. [Conclusion] Positive effects were seen in patients who received PT at 2–4 weeks after surgery. Thus, additional PT for approximately 2 weeks after the beginning of independent ADL may be beneficial. PMID:27190450

  5. Future Management of Carotid Stenosis: Role of Urgent Carotid Interventions in the Acutely Symptomatic Carotid Patient and Best Medical Therapy for Asymptomatic Carotid Disease

    PubMed Central

    Bazan, Hernan A.; Smith, Taylor A.; Donovan, Melissa J.; Sternbergh, W. Charles

    2014-01-01

    Background Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture. In the 1990s, randomized trials demonstrated the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in both symptomatic and asymptomatic carotid disease. Methods We review best medical therapy (BMT) for asymptomatic carotid disease and recent randomized trials comparing CEA and carotid angioplasty stenting (CAS), and we discuss the role of urgent carotid interventions in patients with acute neurologic symptoms. Results In 2010, 2 large trials demonstrated the efficacy of CAS in select patients, although CAS was associated with an increased procedural stroke risk compared to CEA. An age effect was observed; patients >75 years do worse with CAS compared to CEA. As BMT has evolved in the past decade, a future trial (CREST-2) will address whether BMT is equal to intervention (CEA or CAS) in asymptomatic carotid disease. In a subgroup of patients with asymptomatic carotid disease, CEA plus BMT will likely remain the mainstay therapy for carotid disease compared to BMT alone. CEA and CAS will continue to play complementary roles in the future, as CAS will be done in select patients in whom CEA cannot be undertaken because of high-risk anatomical or medical conditions. Finally, a role for urgent carotid interventions in a select group of patients who present with acute neurologic symptoms is developing as a way to prevent recurrent stroke after an initial carotid plaque rupture event. Conclusion CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA

  6. Challenges in the Management of Geriatric Obesity in High Risk Populations

    PubMed Central

    Porter Starr, Kathryn N.; McDonald, Shelley R.; Weidner, Julia A.; Bales, Connie W.

    2016-01-01

    The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults. PMID:27153084

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

    PubMed

    High, K P; Joiner, K A

    1999-04-01

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

  8. Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012

    PubMed Central

    2012-01-01

    The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/or liability for any errors and/or omissions in any abstract as published.

  9. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement: American Geriatrics Society Ethics Committee.

    PubMed

    2015-03-01

    There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high-quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need.

  10. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement: American Geriatrics Society Ethics Committee.

    PubMed

    2015-03-01

    There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high-quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need. PMID:25803784

  11. ECG scores for a triage of patients with acute myocardial infarction transported by the emergency medical system.

    PubMed

    Zalenski, R J; Grzybowski, M; Ross, M A; Blaustein, N; Bock, B

    2000-01-01

    Prehospital triage of cardiac patients for bypass from community hospitals to cardiac centers may improve survival. This article determines if electrocardiogram (ECG)-based scoring triage methods (Aldrich MI scoring, QRS distortion, and the TIMI classification) and location of infarct (via 12 lead ECG) are associated with mortality before and after adjusting for age, sex, and race. It is a retrospective study of 291 AMI adult patients transported by ambulance to community hospitals or cardiac centers. Patients with an ED chief complaint of chest pain or dyspnea, presence of MI as defined by ECG findings of 0.1 mV of ST segment elevation in two leads or positive CPK-MB were eligible for the study. The primary outcome variable was 2-year mortality as determined with a metropolitan Detroit tri-county death index. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (with 95% CIs) of the predictor variables with mortality. Of the initial population selected for the study (n = 291), 229 patients were eligible for the analysis. The mean age was 66 years (SD of 14.4) with 63.8% being male and 54% being white. The overall mortality point estimate was 21.3% (95% CI of 15.2 to 27.3%). Aldrich scores and QRS distortion (yes/no) were not associated with mortality. Patients classified as a "high risk" for AMI per TIMI status were almost 3 times more likely to die than those at "low risk" and reached borderline statistical significance (P = .06) after adjusting for the covariates. Having an anterior infarct, as opposed to an inferior infarct, was significantly associated with death before and after adjusting for the covariates (Unadjusted OR = 2.6, Adjusted OR = 2.8). Properly training emergency medical system professionals in this area may prove useful for identifying higher risk AMI patients in the prehospital setting. PMID:11265729

  12. A systematic approach to the pharmacotherapy of geriatric major depression

    PubMed Central

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

    2014-01-01

    SYNOPSIS While about 14% of older Americans are now taking an antidepressant, this broad use of antidepressants has not been associated with a notable decrease in the burden of geriatric depression. This article, based on a selective review of the literature, explores several explanations for this paradox. First, we discuss and reject the possible explanations that antidepressants are not effective in the treatment of depression or that the results of randomized clinical trials are not applicable to the treatment of depression in “real-world” clinical settings. Instead, we propose that the efficacy of antidepressants depends in large part on the way they are used. We present evidence supporting that the use of antidepressant pharmacotherapy is associated with better outcomes when it is guided by a treatment algorithm (a “stepped care approach”) as opposed to an attempt to individualize treatment. We review published guidelines and pharmacotherapy algorithms that were developed for the treatment of geriatric depression. Finally, we propose an updated algorithm based on the authors’ interpretation of the available evidence. PMID:25037293

  13. [Geriatric nursing staff retention. Opportunities, potentials, and strategies].

    PubMed

    Joost, A

    2013-08-01

    Retaining geriatric nurses in their line of work could be an important strategy to prevent the shortage of skilled staff in the future. A prerequisite for this is detailed knowledge of the length and structure of professional careers. The IWAK ( Institut für Wirtschaft, Arbeit und Kultur) evaluated data from the German Social Insurance and carried out a structural analysis of the professional careers of geriatric nurses. Results showed that the average duration of professional careers is 20 years, of which 11.7 years constitute the period of employment and 7.8 years account for periods of inactivity. According to these findings, there is a considerable potential in extending professional careers and reducing the periods of inactivity to make better use of the existing skilled staff and to reduce staff shortage in this area. Concrete measures could involve improvement of working conditions (with the aim of avoiding long periods of inactivity and illness-related premature career endings as well as of increasing job satisfaction), creating better conditions for a good balance between work and family life, as well as setting up individual strategies to expand weekly working hours. Key players are businesses but also local authorities and politicians.

  14. Where does research occur in geriatrics and gerontology?

    PubMed

    Navarro, Albert; Lynd, Frances E

    2005-06-01

    The International Plan of Action on Aging 2002 emphasized the need to promote and develop research on aging, especially in underdeveloped countries. This article aims at describing the current situation with regard to the international scientific production in the field of geriatrics and gerontology. All articles published in journals included in the categories "Geriatrics and Gerontology" of the Science Citation Index or "Gerontology" of the Social Science Citation Index in 2002 were analyzed. There is unquestionable predomination by the United States, which participates in 53.8% of the articles analyzed, followed by the United Kingdom (9.66%) and Canada (6.66%). The production of the 15 European Union countries together is 31.2%. When adjustments are made for economic or population factors, other countries show their importance: Israel and Sweden, for example. Authors from richer countries participate in more than 95% of the articles, whereas those in less-developed countries tend to publish less, and when they do so, it is through collaboration with more-developed countries. In general, only 10.5% of the articles are written in collaboration with institutions from different countries. One of the keys to stimulating research in less wealthy countries would seem to be precisely through collaboration. This would aid the transfer of knowledge and experience, allowing researchers in these countries to obtain autonomy to perform their own studies independently and to provide them with the ability to gain access for their publications at the international level.

  15. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

    PubMed Central

    Liu, Jun Le; Wang, Xiao Lin; Gong, Mao Wei; Mai, Hai Xing; Pei, Shu Jun; Yuan, Wei Xiu; Zhang, Hong

    2014-01-01

    Background Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive. Objectives We compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty. Materials and methods This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality. Results Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular

  16. Assessment of geriatric knowledge: an online tool for appraising entering APN students.

    PubMed

    Towner, Elizabeth M

    2006-01-01

    As the percentage of elderly in the U.S. rises, the need for primary health care for the aging population increases. Knowledge of special characteristics of older persons, as well as demographics of the aging population, resources and principles of care are important in the provision of effective, professional primary health care by advanced practice nurses. In response to this increasing need for geriatric health care expertise, a tool was developed to evaluate basic geriatric knowledge of students entering advanced practice nursing study, Self Assessment of Geriatric Knowledge. The Self Assessment, derived from AACN's recommended geriatric competencies for BSN graduates, may be accessed on-line. Immediate test results are received on-line. Tests completed by 158 advanced practice students over a three year period showed geriatric knowledge deficits: myths of aging, prevention strategies and risk factors of elders; roles and responsibilities for care of elderly persons in the community; health policies that affect elder care; and, demographics of the geriatric population. These data may contribute to faculty awareness of curricular needs for preparing students for competent geriatric nursing care of the growing older population. PMID:16564477

  17. Assessing the Benefits of a Geropsychiatric Home-Visit Program for Medical Students

    ERIC Educational Resources Information Center

    Roane, David M.; Tucker, Jennifer; Eisenstadt, Ellen; Gomez, Maria; Kennedy, Gary J.

    2012-01-01

    Objective: Authors assessed the benefit of including medical students on geropsychiatric home-visits. Method: Medical students, during their psychiatry clerkship, were assigned to a home-visit group (N=43) or control group (N=81). Home-visit participants attended the initial visit of a home-bound geriatric patient. The Maxwell-Sullivan Attitude…

  18. Police on the front line of community geriatric health care: challenges and opportunities.

    PubMed

    Brown, Rebecca T; Ahalt, Cyrus; Steinman, Michael A; Kruger, Kelly; Williams, Brie A

    2014-11-01

    As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly

  19. Remission in Major Depression: Results from a Geriatric Primary Care Population

    PubMed Central

    Azar, Armin R.; Chopra, Mohit P.; Cho, Lydia Y.; Coakley, Eugenie; Rudolph, James L.

    2010-01-01

    OBJECTIVES While a recent task force report recommended that remission from major depression be defined according to DSM criteria, most previous work has used depressive symptom rating scales. The current study sought to identify baseline factors associated with treatment outcome in major depression, diagnosed according to DSM-IV criteria. METHODS Data from the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study were utilized. This analysis focused on 792 geriatric primary care patients with major depression at baseline, who were randomized to services by a mental health professional in primary care or specialty settings. Major depression was diagnosed according to DSM-IV criteria based on a structured interview at baseline and six months. The primary outcome was the absence of any DSM-IV depressive disorder at six-month follow-up. Association with baseline demographic characteristics, comorbid anxiety disorder, “at risk” drinking, number of co-occurring medical conditions, and depressive symptom severity was examined using multiple logistic regression modeling. RESULTS Remission occurred in 228 (29%) patients with completed follow-up assessments, while 564 (71%) did not remit. Factors which increased the odds of non-remission included comorbid anxiety (OR=1.60, 95%CI 1.11–2.31), female sex (OR=1.49, 95%CI 1.04–2.15), general medical comorbidity (OR=1.15, 95%CI 1.07–1.24), and increased baseline depressive symptom severity (OR=1.04, 95%CI 1.03–1.06). CONCLUSIONS The findings underscore the importance of using DSM criteria to define remission from major depression, and suggest that concurrent measurement of depression severity, comorbid anxiety and medical comorbidity are important in identifying patients requiring targeted interventions to optimize remission from major depression. PMID:21157850

  20. The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.

    PubMed

    Filinson, Rachel; Clark, Phillip G; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.