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  1. 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

  2. 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.

  3. The handling of patients on geriatric wards. A challenge for on-the-job training.

    PubMed

    Takala, E P; Kukkonen, R

    1987-03-01

    Patient lifting habits were studied on seven geriatric wards in five hospitals. The methods used were workplace analysis, questionnaire and video analysis of lifts. Mechanical hoists were regularly used only on the ward that had well organised on-the-job-training. The reasons given for not using the hoist (lack of space or time, etc) were similar on this and the other wards where hoists were used irregularly. Lifting with hoists is slower than without aids, but the total extra time needed for their use is only 3-6% of the 8-hour work shift. Stooped and twisted trunk positions occurred less often when lifting aids were used than without an aid. However, some nurses worked in bad spine-loading positions, even when using lifting aids. To eliminate these postures from nursing work, more attention should be paid to working postures during the organised training of patient handling.

  4. Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh.

    PubMed Central

    Capewell, A E; Primrose, W R; MacIntyre, C

    1986-01-01

    There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly. PMID:3089370

  5. Noise Pollution on an Acute Surgical Ward

    PubMed Central

    McLaren, Emma; Maxwell-Armstrong, Charles

    2008-01-01

    INTRODUCTION This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards. PATIENTS AND METHODS Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison. RESULTS The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night – 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit. CONCLUSIONS The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times

  6. 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

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

    PubMed

    Hawker, M; Romero-Ortuno, R

    2016-01-01

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

  8. 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

  9. [Drug prescriptions of patients treated in a geriatric outpatient ward of a university hospital: a descriptive cross-sectional study].

    PubMed

    Cuentro, Vanessa da Silva; Andrade, Marcieni Ataide de; Gerlack, Letícia Farias; Bós, Angelo José Gonçalves; Silva, Marcos Valério Santos da; Oliveira, Alex Ferreira de

    2014-08-01

    The scope of this study was to evaluate drug prescriptions for elderly patients in the geriatric outpatient ward of a hospital. A cross-sectional descriptive study was conducted in a university hospital, with the application of a questionnaire. Patients aged >60 years were interviewed about their drug prescriptions and a total of 208 patients were interviewed. The average number of drugs used per person was 3.8 and the drugs most used were for the cardiovascular system (37%). 406 potential interactions were identified in 140 patients (67.3%), and duplicate therapy was found in two prescriptions. The potentially inappropriate drug most used for the elderly was nifedipine (2.4%). Data from this study support the relevance of the issue of drug use among the elderly, thus reinforcing the importance of the evaluation of the process of the prescription of drugs for this population. PMID:25119075

  10. Anxiety and depression on an acute respiratory ward

    PubMed Central

    Thew, Graham R; MacCallam, Jackie; Salkovskis, Paul M; Suntharalingam, Jay

    2016-01-01

    Objectives: Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission. Methods: A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety. Results: Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns. Conclusion: We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted. PMID:27508081

  11. [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.

  12. Team clinical supervision in acute hospital wards: a feasibility study.

    PubMed

    O'Connell, Bev; Ockerby, Cherene M; Johnson, Susan; Smenda, Helen; Bucknall, Tracey K

    2013-03-01

    Clinical supervision provides a strategy to mitigate nurses' workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- (n = 36) and postintervention (n = 27), and focus groups (n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings. PMID:21531902

  13. 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

  14. A randomised controlled trial of long stay nursing home and geriatric ward care for the elderly. A summary of main findings.

    PubMed

    Bowling, A; Formby, J; Clark, P

    1992-01-01

    This paper reports outcome data on mental and physical ability levels, mortality and accidents rates, from a randomised controlled trial evaluating health authority funded nursing home and long stay geriatric ward care in one inner London health district. There were no differences between settings in relation to mortality rates, although respondents randomised to the nursing homes deteriorated more rapidly in overall and functional ability levels; they also experienced a higher accident rate than respondents in the wards. This has to be balanced against the previously published observational data from the evaluation which clearly indicated that quality of life in the homes was superior to that in the wards. There was more occupational therapy input into the wards in comparison with the homes, and activities were promoted most in the patient's Club in the hospital setting. Although quality of life was superior in the homes in relation to flexibility and preservation of resident's dignity.

  15. Development and validation of scales to measure organisational features of acute hospital wards.

    PubMed

    Adams, A; Bond, S; Arber, S

    1995-12-01

    In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

  16. Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.

    PubMed

    Bowers, Len; Stewart, Duncan; Papadopoulos, Chris; Iennaco, Joanne DeSanto

    2013-05-01

    OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

  17. 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.

  18. 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

  19. 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…

  20. Leadership support for ward managers in acute mental health inpatient settings.

    PubMed

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. PMID:24779763

  1. Leadership support for ward managers in acute mental health inpatient settings.

    PubMed

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

  2. 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.

  3. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    PubMed

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

    2015-01-01

    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

  4. 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

  5. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    PubMed Central

    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  6. 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

  7. 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…

  8. Acute bacterial skin and skin structure infections in internal medicine wards: old and new drugs.

    PubMed

    Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco

    2016-08-01

    Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed. PMID:27084183

  9. 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

  10. Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used?

    PubMed

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Helen Mjøsund, Nina; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2013-08-30

    Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.

  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. Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

    PubMed

    Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A

    2000-01-01

    The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758

  13. Neural network modeling of the level of observation decision in an acute psychiatric ward.

    PubMed

    Penny, W D; Frost, D P

    1997-02-01

    Patients in an acute psychiatric ward need to be observed with varying levels of closeness. We report a series of experiments in which neural networks were trained to model this "level of observation" decision. One hundred eighty-seven such clinical decisions were used to train and test the networks which were evaluated by a multitrial v-fold cross-validation procedure. One neural network modeling approach was to break down the decision process into four subproblems, each of which was solved by a perceptron unit. This resulted in a hierarchical perceptron network having a structure that was equivalent to a sparsely connected two-layer perceptron. Neural network approaches were compared with nearest neighbor, linear regression, and naive Bayes classifiers. The hierarchical and sparse neural networks were the most accurate classifiers. This shows that the decision process is nonlinear, that neural nets can be more accurate than other statistical approaches, and that hierarchical decomposition is a useful methodology for neural network design.

  14. 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

  15. 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.

  16. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    PubMed

    Quirk, Alan; Lelliott, Paul; Seale, Clive

    2006-10-01

    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

  17. "Talking in a new way": older individuals' experiences of group work in an acute psychiatric ward.

    PubMed

    Partington, Jennifer; Gee, Susan; Leith, Anne-Marie; Croucher, Matthew

    2012-01-01

    Group work is frequently used in mental health, however qualitative studies on service-users' views are rare. Semistructured interviews explored 12 participants' experiences of a café-style social group and a mutual-aid group offered on an older persons psychiatric ward in Christchurch, New Zealand. The values of the strengths-based approach underpinning the groups were reflected back in the experience of an affirming environment, an exchange of strengths, and the capacity to change. The appeal of the café-style may be culturally specific to European women however, reinforcing the importance of an awareness of culture and diversity.

  18. Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

    PubMed

    Gregory, Linda Rosemary; Hopwood, Nick; Boud, David

    2014-05-01

    It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning. PMID:24404847

  19. Interprofessional learning at work: what spatial theory can tell us about workplace learning in an acute care ward.

    PubMed

    Gregory, Linda Rosemary; Hopwood, Nick; Boud, David

    2014-05-01

    It is widely recognized that every workplace potentially provides a rich source of learning. Studies focusing on health care contexts have shown that social interaction within and between professions is crucial in enabling professionals to learn through work, address problems and cope with challenges of clinical practice. While hospital environments are beginning to be understood in spatial terms, the links between space and interprofessional learning at work have not been explored. This paper draws on Lefebvre's tri-partite theoretical framework of perceived, conceived and lived space to enrich understandings of interprofessional learning on an acute care ward in an Australian teaching hospital. Qualitative analysis was undertaken using data from observations of Registered Nurses at work and semi-structured interviews linked to observed events. The paper focuses on a ward round, the medical workroom and the Registrar's room, comparing and contrasting the intended (conceived), practiced (perceived) and pedagogically experienced (lived) spatial dimensions. The paper concludes that spatial theory has much to offer understandings of interprofessional learning in work, and the features of work environments and daily practices that produce spaces that enable or constrain learning.

  20. Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.

    PubMed

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Mjøsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2014-01-30

    This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.

  1. Different characteristics associated with intensive care unit transfer from the medical ward between patients with acute exacerbations of chronic obstructive pulmonary disease with and without pneumonia

    PubMed Central

    Shin, Hong-Joon; Park, Cheol-Kyu; Kim, Tae-Ok; Ban, Hee-Jung; Oh, In-Jae; Kim, Yu-Il; Kwon, Yong-Soo; Kim, Young-Chul

    2016-01-01

    Background The rate of hospitalization due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is increasing. Few studies have examined the clinical, laboratory and treatment differences between patients in general wards and those who need transfer to an intensive care unit (ICU). Methods We retrospectively reviewed clinical, laboratory, and treatment characteristics of 374 patients who were initially admitted to the general ward at Chonnam National University Hospital in South Korea due to AECOPD (pneumonic, 194; non-pneumonic, 180) between January 2008 and March 2015. Of these patients, 325 were managed at the medical ward during their hospitalization period (ward group), and 49 required ICU transfer (ICU group). We compared the clinical, laboratory, and treatment characteristics associated with ICU transfer between patients with AECOPD with and without pneumonia. Results Male patients were 86.5% in the ward group and 79.6% in the ICU group. High glucose levels [median 154.5 mg/dL, interquartile range (IQR) 126.8–218.3 in ICU group vs. median 133.0, IQR 109.8–160.3 in ward group], high pneumonia severity index scores (median 100.5, IQR 85.5–118.5 vs. median 86.0, IQR 75.0–103.5), low albumin levels (median 2.9 g/dL, IQR 2.6–3.6 vs. median 3.4, IQR 3.0–3.7), and anemia (73.3% vs. 43.3%) independently increased the risk of ICU transfer in the pneumonic AECOPD group. High PaCO2 levels (median 53.1 mmHg in ICU group, IQR 38.5–84.6 vs. median 39.7, IQR 34.2–48.6 in ward group) independently increased the risk of ICU transfer in the non-pneumonic AECOPD group. Treatment with systemic corticosteroids (≥30 mg of daily prednisolone) during hospitalization in the medical ward independently reduced the risk of ICU transfer in both groups. Conclusions The characteristics associated with ICU transfer differed between the pneumonic and non-pneumonic AECOPD groups, and systemic corticosteroids use was associated with lower rate of ICU

  2. Influence of drugs of abuse and alcohol upon patients admitted to acute psychiatric wards: physician's assessment compared to blood drug concentrations.

    PubMed

    Mordal, Jon; Medhus, Sigrid; Holm, Bjørn; Mørland, Jørg; Bramness, Jørgen G

    2013-06-01

    In acute psychiatric services, rapid and accurate detection of psychoactive substance intake may be required for appropriate diagnosis and intervention. The aim of this study was to investigate the relationship between (a) drug influence as assessed by physicians and (b) blood drug concentrations among patients admitted to acute psychiatric wards. We also explored the possible effects of age, sex, and psychotic symptoms on physician's assessment of drug influence. In a cross-sectional study, the sample comprised 271 consecutive admissions from 2 acute psychiatric wards. At admission, the physician on call performed an overall judgment of drug influence. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Blood samples were screened for a wide range of psychoactive substances, and quantitative results were used to calculate blood drug concentration scores. Patients were judged as being under the influence of drugs and/or alcohol in 28% of the 271 admissions. Psychoactive substances were detected in 56% of the blood samples. Altogether, 15 different substances were found; up to 8 substances were found in samples from 1 patient. Markedly elevated blood drug concentration scores were estimated for 15% of the patients. Physician's assessment was positively related to the blood drug concentration scores (r = 0.52; P < 0.001), to symptoms of excitement, and to the detection of alcohol, cannabis, and amphetamines. The study demonstrates the major impact of alcohol and drugs in acute psychiatric settings and illustrates the challenging nature of the initial clinical assessment.

  3. 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

  4. 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,…

  5. [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

  6. 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

  7. 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.

  8. 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

  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. Improving the quality of care for medical inpatients by placing a higher priority on ward rounds.

    PubMed

    Soliman, Ash; Riyaz, Shahzad; Said, Elmhutady; Hale, Melissa; Mills, Andy; Kapur, Kapil

    2013-12-01

    Models suggested for managing acute, non-elective, medical admissions include expanding geriatric services, extending the role of the acute physician and rejuvenating the role of the general physician. We investigated improving inpatient care by changing consultants' work patterns and placing a higher priority on the ward rounds. A focus group and a questionnaire were used to study the impact on several ward round parameters. All respondents reported an overall satisfaction: 93% rated the quality of care as good or excellent, 75% reported increased safe patient discharges and 68% observed improved teamwork. Length of stay reduced to 4 days from 5.3 days without an increase in readmission. The main themes showed improved quality of care, better assured patients and relatives, and better consultant job satisfaction, but also showed reduced junior doctors' independent decision-making and a slight reduction in specialty-related activity. The study concluded that placing a higher priority on ward rounds by altering consultants' work patterns has a positive impact on inpatient care. PMID:24298094

  11. Delivering dementia care differently—evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards: a qualitative study of family carers’ perceptions of quality of care

    PubMed Central

    Spencer, Karen; Foster, Pippa; Whittamore, Kathy H; Goldberg, Sarah E; Harwood, Rowan H

    2013-01-01

    Objectives To examine in depth carers’ views and experiences of the delivery of patient care for people with dementia or delirium in an acute general hospital, in order to evaluate a specialist Medical and Mental Health Unit (MMHU) compared with standard hospital wards. This qualitative study complemented the quantitative findings of a randomised controlled trial. Design Qualitative semistructured interviews were conducted with carers of patients with cognitive impairment admitted to hospital over a 4-month period. Setting A specialist MMHU was developed in an English National Health Service acute hospital aiming to deliver the best-practice care. Specialist mental health staff were integrated with the ward team. All staff received enhanced training in dementia, delirium and person-centred care. A programme of purposeful therapeutic and leisure activities was introduced. The ward environment was optimised to improve patient orientation and independence. A proactive and inclusive approach to family carers was encouraged. Participants 40 carers who had been recruited to a randomised controlled trial comparing the MMHU with standard wards. Results The main themes identified related closely to family carers’ met or unmet expectations and included activities and boredom, staff knowledge, dignity and fundamental care, the ward environment and communication between staff and carers. Carers from MMHU were aware of, and appreciated, improvements relating to activities, the ward environment and staff knowledge and skill in the appropriate management of dementia and delirium. However, communication and engagement of family carers were still perceived as insufficient. Conclusions Our data demonstrate the extent to which the MMHU succeeded in its goal of providing the best-practice care and improving carer experience, and where deficiencies remained. Neither setting was perceived as neither wholly good nor wholly bad; however, greater satisfaction (and less dissatisfaction

  12. 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

  13. Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

    PubMed Central

    Yalcinsoy, Murat; Salturk, Cuneyt; Oztas, Selahattin; Gungor, Sinem; Ozmen, Ipek; Kabadayi, Feyyaz; Oztim, Aysem Askim; Aksoy, Emine; Adıguzel, Nalan; Oruc, Ozlem; Karakurt, Zuhal

    2016-01-01

    Purpose Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward. Patients and methods This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25) and group 2 (pH=7.26–7.30). Results Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward. Conclusion NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. PMID:27330283

  14. The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

    NASA Astrophysics Data System (ADS)

    Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

    1993-06-01

    Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

  15. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran.

    PubMed

    Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid

    2016-01-01

    In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients' medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients' outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176

  16. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran

    PubMed Central

    Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid

    2016-01-01

    In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients’ medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients’ outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176

  17. 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

  18. Improving surgical inpatient ward lists in a large acute hospital: a simple yet effective process to save the time of junior house officers.

    PubMed

    Kenny, Ross; Johnston, Carolyn; Qureshi, Imran

    2014-01-01

    In order for the smooth running of a surgical firm, an effective ward list must be created, updated, and edited each day, often by junior medical personnel. Ward lists are used by various healthcare professionals including consultants, specialist nurses, and pharmacists. Over time ward inpatient lists can become increasingly difficult to use and lacking in vital information. Baseline measurement revealed the extent of the problem with junior house officers spending on average 95 minutes per day maintaining the ward list. After a period of research and learning, a bespoke inpatient list was created containing all of the vital information required. Criteria to fulfil included being straightforward to manipulate, easy to input new patients and aesthetically pleasing. After a trial period with modifications, an improved inpatient ward list was successfully implemented. Post-intervention data collection revealed a reduction of 42 minutes per day on average spent maintaining the list, with a 100% increase in satisfaction, and reduction in problems encountered from daily to weekly. Following this success, the general surgery weekend handover list was improved using the same prototype. This led to a saving of 8 minutes per day on average and increased doctor satisfaction. The process of creating an effective, easy to use, and useful inpatient ward list can lead to large amount of time saved each day for the staff responsible for its management. This time can then be reinvested on clinical duties, or education, to further improve the healthcare service we provide. PMID:26734290

  19. Psychiatric wards: places of safety?

    PubMed

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience.

  20. Psychiatric wards: places of safety?

    PubMed

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience. PMID:20465757

  1. 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

  2. [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

  3. 4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO THE SOUTH - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

  4. 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

  5. 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

  6. 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.

  7. [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

  8. 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

  9. 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.

  10. 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

  11. [Interface ward round].

    PubMed

    Fischer, Martin Rudolf; Wölfel, Teresa; Schmidmaier, Ralf

    2016-01-01

    Ward rounds are the pivot point of the daily routine on internal medicine wards. They are crucial to the interprofessional team to inform the patient and his relatives, to gather new information as well as to plan further diagnostics, evaluation of prognosis and therapy. Furthermore, medical rounds provide an important setting for situational learning and reflection of alternatives of action in terms of evidence based medicine. The war round is a vital component of the patient-doctor communication and contributes strongly to patient safety. PMID:26710200

  12. Characteristics and dying trajectories of adult hospital patients from acute care wards who die following review by the rapid response team.

    PubMed

    Coombs, M A; Nelson, K; Psirides, A J; Suter, N; Pedersen, A

    2016-03-01

    A third of patients reviewed by rapid response teams (RRT) require end-of-life care. However, little is known about the characteristics and management of these patients following RRT review. This paper presents results of a retrospective, descriptive audit that explored the dying trajectory of adult ward inpatients who died outside of intensive care following RRT review. The study setting was a 430-bed tertiary New Zealand hospital during 2013. RRT, inpatient databases and hospital notes were used to identify 100 consecutive adult inpatients who died subsequent to RRT review. Outcome measures included time from RRT review to death, place of death, pre-existing co-morbidities and frequency of medical review. Results demonstrated that patients were old (median 77 years, IQR 63-85years), emergency admissions (n=100) and admitted under a medical specialty (n=71). All but one of the cohort had pre-existing co-morbidities (mean 3.2, SD 1.7), almost a third (n=31) had cancer and 51% had 1-4 previous inpatient admissions within the previous 12 months. The mean length of stay prior to RRT review was 4.9 days (SD 5.5) during which patients were frequently reviewed by senior medical staff (mean 6.8 times, SD 6.9, range 0-44). Twenty per cent of patients died after their first RRT review with a further 40% receiving treatment limitation/palliation. Fifty-two per cent of patients had a pre-existing DNAR. Eighty per cent of patients died in hospital. Whilst the RRT fulfils an unmet need in decision-making at end of life, there is a need to understand what RRT, instead of ward-based or palliative care teams, offers dying patients. PMID:27029659

  13. Transmission of endemic ST22-MRSA-IV on four acute hospital wards investigated using a combination of spa, dru and pulsed-field gel electrophoresis typing.

    PubMed

    Creamer, E; Shore, A C; Rossney, A S; Dolan, A; Sherlock, O; Fitzgerald-Hughes, D; Sullivan, D J; Kinnevey, P M; O'Lorcain, P; Cunney, R; Coleman, D C; Humphreys, H

    2012-11-01

    The transmission of meticillin-resistant Staphylococcus aureus (MRSA) between individual patients is difficult to track in institutions where MRSA is endemic. We investigated the transmission of MRSA where ST22-MRSA-IV is endemic on four wards using demographic data, patient and environmental screening, and molecular typing of isolates. A total of 939 patients were screened, 636 within 72 h of admission (on admission) and 303 >72 h after admission, and 1,252 environmental samples were obtained. Isolates were typed by spa, dru and pulsed-field gel electrophoresis (PFGE) typing. A composite dendrogram generated from the three sets of typing data was used to divide isolates into 'dendrogram groups' (DGs). Ten percent of patients (92/939) were MRSA-positive; 7 % (44/636) on admission and 16 % (48/303) >72 h after admission (p = 0.0007). MRSA was recovered from 5 % of environmental specimens (65/1,252). Most isolates from patients (97 %, 85/88) and the environment (97 %, 63/65) exhibited the ST22-MRSA-IV genotype. Four DGs (DG1, DG4, DG16 and DG17) accounted for 58 % of ST22-MRSA-IV isolates from patients. Epidemiological evidence suggested cross-transmission among 44/92 patients (48 %) but molecular typing confirmed probable cross-transmission in only 11 instances (13 %, 11/88), with the majority of cross-transmission (64 %; 7/11) occurring on one ward. In the setting of highly clonal endemic MRSA, the combination of local epidemiology, PFGE, spa and dru typing provided valuable insights into MRSA transmission.

  14. 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

  15. 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…

  16. 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…

  17. 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

  18. Doctor Ward's Accidental Terrarium.

    ERIC Educational Resources Information Center

    Hershey, David R.

    1996-01-01

    Presents the story of the accidental invention of the Wardian case, or terrarium, by Nathaniel Bagshaw Ward. Advocates the use of this story in teaching precollege biology as an illustration of how a chance event can lead to a major scientific advancement and as an example of the common occurrence of multiple discovery in botany. Contains 34…

  19. Christmas in the ward.

    PubMed

    For most people Christmas is traditionally a home-centred celebration, but for many nurses Christmas Day is spent at work. How do those nurses combine family commitments and professional ones? Is working on Christmas Day a joy or a chore? The Lamp spoke to a number of nurses who are veterans of a Christmas in the ward to find out.

  20. 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)

  1. 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

  2. Prevalence of infections and their risk factors in geriatric institutions: a one-day multicentre survey.

    PubMed Central

    Michel, J. P.; Lesourd, B.; Conne, P.; Richard, D.; Rapin, C. H.

    1991-01-01

    This one-day prevalence survey of 1919 patients (74% females and 44% aged greater than or equal to 85 years) in nine geriatric hospitals, six of them located in France and three in Switzerland, indicated a high prevalence of infections in elderly institutionalized patients (infection rate: 18.7% in males and 15.4% in females). The risk factors for infection were identified and the relative risks assessed. Prevention of infections in geriatric wards should be one of the goals of every care-giver. A low rate of infection in elderly inpatients is thus likely to be associated with care of good quality. PMID:1905207

  3. 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

  4. 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…

  5. A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards.

    PubMed

    Medhus, Sigrid; Mordal, Jon; Holm, Bjørn; Mørland, Jørg; Bramness, Jørgen G

    2013-03-30

    Psychosis induced by the use of amphetamine or methamphetamine leads to dramatic symptoms and frequent readmissions and poses diagnostic challenges. Earlier studies have often relied on history taking and/or urine samples to reveal drug use. The aim of this study was to compare the psychotic symptoms of two groups: (1) acutely admitted patients who tested positive for methamphetamines and were diagnosed with drug-induced or methamphetamine-induced psychoses and (2) acutely admitted patients who tested negative for methamphetamines and were diagnosed with schizophrenia. Blood and urine samples were used. In addition, we investigated whether the severity of symptoms, in those who tested positive, was related to the blood concentration of methamphetamine. Of 285 patients who volunteered blood and/or urine samples within 48h of admission, 37 (13%) had recently taken methamphetamine. Positive psychotic symptoms between the two groups were compared by PANSS using the positive subscale. The results showed no differences in positive psychotic symptoms between the two groups. The severity of positive psychotic symptoms in patients with three different levels of urine/blood methamphetamine concentrations, were compared. We found no clinically or statistically significant relationship between blood methamphetamine levels and severity of psychotic symptoms.

  6. 15. New York Connecting Railroad: Wards Island Viaduct. Wards Island, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. New York Connecting Railroad: Wards Island Viaduct. Wards Island, New York Co., NY. Sec. 4207, MP 7.65. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York County, NY

  7. Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

    PubMed Central

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Hossain, Md Iqbal; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Imran, Gazi; Ahmed, Tahmeed

    2013-01-01

    Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and

  8. 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.

  9. 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)

  10. 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 ...

  11. 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

  12. A descriptive study of nasogastric tube feeding among geriatric inpatients in Malaysia: utilization, complications, and caregiver opinions.

    PubMed

    Nordin, Nordiana; Kamaruzzaman, Shahrul Bahyah; Chin, Ai-Vyrn; Poi, Philip J H; Tan, Maw Pin

    2015-01-01

    The strong emphasis on feeding in Asian cultures may influence decisions for nasogastric (NG) tube feeding in geriatric inpatients. We evaluated the utility, complications, and opinions of caregivers toward NG tube feeding in an acute geriatric ward in a teaching hospital in Kuala Lumpur. Consecutive patients aged 65 years and older receiving NG tube feeding were included. Sociodemographic, clinical, and laboratory indices were recorded. Opinion on NG tube feeding were evaluated through face-to-face interviews with caregivers, recruited through convenience sampling. Of 432 patients admitted, 96 (22%), age ± standard deviation = 80.8 ± 7.4 years, received NG tube feeding. The complication and mortality rates were 69% and 38%, respectively. Diabetes (odds ratio [95% confidence interval] = 3.34 [1.07, 10.44], aspiration pneumonia (8.15 [2.43, 27.24]), impaired consciousness (3.13 [1.05, 9.36]), and albumin ≤26 g/dl (4.43 [1.46, 13.44]) were independent predictors of mortality. Other relatives were more likely than spouses (23.5 [3.59, 154.2]) and caregivers with tertiary education more likely than those with no formal education ( 18 [1.23, 262.7]) to agree to NG feeding. Sixty-four percent of caregivers felt NG tube feeding was appropriate at the end of life, mostly due to the fear of starvation. NG tube feeding is widely used in our setting, despite high complication and mortality rates, with likely influences from cultural emphasis on feeding.

  13. A descriptive study of nasogastric tube feeding among geriatric inpatients in Malaysia: utilization, complications, and caregiver opinions.

    PubMed

    Nordin, Nordiana; Kamaruzzaman, Shahrul Bahyah; Chin, Ai-Vyrn; Poi, Philip J H; Tan, Maw Pin

    2015-01-01

    The strong emphasis on feeding in Asian cultures may influence decisions for nasogastric (NG) tube feeding in geriatric inpatients. We evaluated the utility, complications, and opinions of caregivers toward NG tube feeding in an acute geriatric ward in a teaching hospital in Kuala Lumpur. Consecutive patients aged 65 years and older receiving NG tube feeding were included. Sociodemographic, clinical, and laboratory indices were recorded. Opinion on NG tube feeding were evaluated through face-to-face interviews with caregivers, recruited through convenience sampling. Of 432 patients admitted, 96 (22%), age ± standard deviation = 80.8 ± 7.4 years, received NG tube feeding. The complication and mortality rates were 69% and 38%, respectively. Diabetes (odds ratio [95% confidence interval] = 3.34 [1.07, 10.44], aspiration pneumonia (8.15 [2.43, 27.24]), impaired consciousness (3.13 [1.05, 9.36]), and albumin ≤26 g/dl (4.43 [1.46, 13.44]) were independent predictors of mortality. Other relatives were more likely than spouses (23.5 [3.59, 154.2]) and caregivers with tertiary education more likely than those with no formal education ( 18 [1.23, 262.7]) to agree to NG feeding. Sixty-four percent of caregivers felt NG tube feeding was appropriate at the end of life, mostly due to the fear of starvation. NG tube feeding is widely used in our setting, despite high complication and mortality rates, with likely influences from cultural emphasis on feeding. PMID:25803603

  14. 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.

  15. 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.

  16. 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

  17. Diagnostic value of procalcitonin in acutely hospitalized elderly patients.

    PubMed

    Steichen, O; Bouvard, E; Grateau, G; Bailleul, S; Capeau, J; Lefèvre, G

    2009-12-01

    The aim of this study was to evaluate procalcitonin as an adjunct to diagnose bacterial infections in older patients. One hundred seventy-two patients admitted to an acute-care geriatric unit during a 6-month period were prospectively included, 39 of them with an invasive bacterial infection. The best cut-off value to rule in a bacterial infection was 0.51 microg/l with sensitivity 64% and specificity 94%. The best cut-off value to rule out a bacterial infection was 0.08 microg/l with sensitivity 97% and specificity 20%. Procalcitonin was inconclusive (between 0.08 and 0.51 microg/l) for 112 admissions. Procalcitonin over 0.51 microg/l was useless 22 times out of 33 (infection already ruled in on clinical grounds) and misleading in eight of the 11 remaining cases (no infection). Procalcitonin below 0.08 microg/l was useless 23 times out of 27 (infection already ruled out on clinical grounds) and misleading in one of the four remaining cases (infection). Despite a good overall diagnostic accuracy, the clinical usefulness of PCT to diagnose invasive bacterial infections in elderly patients hospitalized in an acute geriatric ward appears to be very limited. PMID:19727867

  18. 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)

  19. [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

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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)

  5. 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

  6. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  7. Safer Wards: reducing violence on older people's mental health wards.

    PubMed

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  8. Safer Wards: reducing violence on older people's mental health wards

    PubMed Central

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  9. [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

  10. [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.

  11. 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

  12. 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

  13. 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.

  14. [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.

  15. 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

  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. Improving fluid balance monitoring on the wards

    PubMed Central

    Jeyapala, Sobanakumari; Gerth, Alice; Patel, Aarti; Syed, Nazia

    2015-01-01

    Clinical experience and nursing metrics have consistently identified poor documentation of fluid balance monitoring at Milton Keynes University Hospital, compromising patient safety and quality of care. This project aimed to increase the percentage of fluid balance charts correctly completed on the wards. Three areas for improvement were identified: understanding the importance of good fluid balance monitoring, correct identification of patients requiring monitoring, and ease of completion of fluid balance charts. Three interventions were deployed on two acute medical awards in consecutive cycles; 1) small group education for staff, 2) creation of board magnets to aid the multidisciplinary team to identify patients requiring monitoring, 3) modification of the current fluid balance chart. Questionnaires were utilised to highlight improvements with current charts and measured staff awareness pre and post education. Each intervention was implemented for one week followed by daily surveys for four days to monitor compliance. Initial results showed a range of 6-12 charts used daily per ward. Of these 0-45% of them were correctly filled. Post education there was a reduced number of inappropriate charts. Introduction of board magnets improved correlation between doctors and nurses in identification of patients (52% before, 77% after magnets). Following modification there was a subjective improvement in the quality of chart completion. This study highlighted that understanding and use of fluid balance monitoring can be improved for nurses, health care assistants (HCAs), and doctors. These improvements allow better documentation and safer patient care. As a result, Milton Keynes University Hospital is investing in magnets and modified charts for a Trust-wide pilot. PMID:26734450

  18. 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

  19. [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.

  20. 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.

  1. [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.

  2. 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…

  3. 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…

  4. Food hygiene on the wards.

    PubMed

    Steuer, Walter

    2007-09-13

    A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food

  5. 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

  6. 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

  7. 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).

  8. 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.

  9. 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…

  10. Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward

    PubMed Central

    Tsuchiya, Kenji; Fujita, Takaaki; Sato, Daisuke; Midorikawa, Manabu; Makiyama, Yasushi; Shimoda, Kaori; Tozato, Fusae

    2016-01-01

    [Purpose] There have been no investigations into the improvement of activities of daily living among patients suffering from post-stroke depression on admission to convalescent rehabilitation wards in Japan. This study aimed to assess the improvement of activities in daily living in patients with or without post-stroke depression at the time of admission to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study included 108 stroke patients divided into two groups according to their Geriatric Depression Scale 15-item short form scores. Activities of daily living were assessed using the Functional Independence Measure. The degree of improvement on the Functional Independence Measure was defined as the difference between scores on admission and at discharge. [Results] The Functional Independence Measure gain score was significantly different from the Functional Independence Measure total score. There was a significant interaction between time period and post-stroke depression factors for the Functional Independence Measure total score. A multiple regression analysis revealed a significant association between Geriatric Depression Scale score and Functional Independence Measure total score. [Conclusion] The present study suggests that post-stroke depression has a negative impact on recovery of activities of daily living and on rehabilitation outcomes in a convalescent rehabilitation ward setting. PMID:27630408

  11. Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward

    PubMed Central

    Tsuchiya, Kenji; Fujita, Takaaki; Sato, Daisuke; Midorikawa, Manabu; Makiyama, Yasushi; Shimoda, Kaori; Tozato, Fusae

    2016-01-01

    [Purpose] There have been no investigations into the improvement of activities of daily living among patients suffering from post-stroke depression on admission to convalescent rehabilitation wards in Japan. This study aimed to assess the improvement of activities in daily living in patients with or without post-stroke depression at the time of admission to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study included 108 stroke patients divided into two groups according to their Geriatric Depression Scale 15-item short form scores. Activities of daily living were assessed using the Functional Independence Measure. The degree of improvement on the Functional Independence Measure was defined as the difference between scores on admission and at discharge. [Results] The Functional Independence Measure gain score was significantly different from the Functional Independence Measure total score. There was a significant interaction between time period and post-stroke depression factors for the Functional Independence Measure total score. A multiple regression analysis revealed a significant association between Geriatric Depression Scale score and Functional Independence Measure total score. [Conclusion] The present study suggests that post-stroke depression has a negative impact on recovery of activities of daily living and on rehabilitation outcomes in a convalescent rehabilitation ward setting.

  12. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods

    PubMed Central

    Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

    2016-01-01

    Abstract Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. PMID:26886239

  13. [Poison cases and types of poisons based on data obtained of patients hospitalized from 1995-2009 with acute poisoning in the second internal ward in a multi-profile provincial hospital in Tarnow].

    PubMed

    Lata, Stanisław; Janiszewski, Jacek

    2010-01-01

    The thesis presents a short history and organization of an acute poisoning centre in the1995 functioning within the internal diseases department in a multi-profile provincial hospital. The data show the number of patients treated beetween 1995-2009 an the types of toxic substances that caused poisoning. The conclusions presented refer to the role of the centre to help people suffering from acute poisoning within the city of Tarnow.

  14. Food hygiene on the wards.

    PubMed

    Steuer, Walter

    2007-01-01

    A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food

  15. 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.

  16. 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)

  17. [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.

  18. 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…

  19. Chronotherapeutics in a psychiatric ward.

    PubMed

    Benedetti, Francesco; Barbini, Barbara; Colombo, Cristina; Smeraldi, Enrico

    2007-12-01

    Psychiatric chronotherapeutics is the controlled exposure to environmental stimuli that act on biological rhythms in order to achieve therapeutic effects in the treatment of psychiatric conditions. In recent years some techniques (mainly light therapy and sleep deprivation) have passed the experimental developmental phase and reached the status of powerful and affordable clinical interventions for everyday clinical treatment of depressed patients. These techniques target the same brain neurotransmitter systems and the same brain areas as do antidepressant drugs, and should be administered under careful medical supervision. Their effects are rapid and transient, but can be stabilised by combining techniques among themselves or together with common drug treatments. Antidepressant chronotherapeutics target the broadly defined depressive syndrome, with response and relapse rates similar to those obtained with antidepressant drugs, and good results are obtained even in difficult-to-treat conditions such as bipolar depression. Chronotherapeutics offer a benign alternative to more radical treatments of depression for the treatment of severe depression in psychiatric wards, but with the advantage of rapidity of onset.

  20. 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.

  1. Medication communication during ward rounds on medical wards: Power relations and spatial practices.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2013-03-01

    Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals. PMID:22674748

  2. Medication communication during ward rounds on medical wards: Power relations and spatial practices.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2013-03-01

    Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.

  3. 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

  4. 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…

  5. [Activity in a nephrology ward in 2009, Piemonte, Italy].

    PubMed

    Rollino, Cristiana; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Maina, Luca; Massara, Carlo; Quarello, Francesco

    2011-01-01

    The characteristics of patients hospitalized in nephrology wards in Italy have changed in recent years due to the aging Italian population and the increased immigration. We analyzed the demographic and clinical characteristics of patients hospitalized in our nephrology ward (17 beds) from 15 November 2008 to 15 November 2009. In this period there were 507 hospitalizations including 448 patients. The mean age was 64.4+/-18 years (range 16-96 years). Foreigners accounted for 10% of the total; their mean age was significantly lower than that of Italian patients (38.2+/-13.4 vs 67.4+/-15.9 years, p<0.01). 36.3% of patients were on dialysis, 10% were transplant recipients: the reasons for admission in these cases were internal medicine related; 18.15% were hospitalized because of emergency unit crowding without indications for admission to a nephrology ward. Hospitalization lasted a mean of 13+/-13 days. The most frequent diagnosis at discharge was acute renal failure (ARF) (28.9%) (prerenal 42.1%, obstructive 12.2%, drug induced 6.8%, other causes of ARF 38.7%). Patients with ARF were older than patients with other kidney conditions (67.05+/-16.98 vs 56.03+/-18.65 years, p<0.01). ARF resolved or improved in 86 patients (63.7%). Other diagnoses were cardiovascular disease 25.1%, glomerular disease 18.7%, acute pyelonephritis 10.6%, other 16.7%. Foreign patients presented infectionrelated diseases more often than Italian patients (39.2% vs 20.4%, p=0.02). 392 patients were discharged to their homes, 40 (7.9%) found a place in a long-term care facility or home for the elderly, 25 (4.9%) in other hospital units, and 50 patients died (9.8%). In conclusion, patients hospitalized in nephrology wards in 2009 were mostly elderly with a high frequency of cardiovascular disease and diabetes. The most frequent diagnosis was prerenal ARF. These data suggest the necessity of improving the prevention of this type of kidney disease. Moreover, the length of hospitalization, which is

  6. 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

  7. 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.

  8. Operation Ward's Island, A Guide to the Trees and Other Features of Ward's Island.

    ERIC Educational Resources Information Center

    New York City Board of Education, Brooklyn, NY. Bureau of Curriculum Development.

    This guide for teachers, students, and adults illustrates how it is possible to use Ward's Island as an outdoor laboratory. It contains a guide to 30 kinds of trees on the island, along with clearly drawn maps and illustrations. The guide helps the user to locate these trees along two nature trails. A section called "Ward's Island Roundup" briefly…

  9. 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

  10. 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

  11. The health-care environment on a locked psychiatric ward: an ethnographic study.

    PubMed

    Johansson, Inger M; Skärsäter, Ingela; Danielson, Ella

    2006-12-01

    Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.

  12. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada.

    PubMed

    Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema

    2012-10-01

    Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards.

  13. 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

  14. 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…

  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.

  16. 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

  17. 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.…

  18. 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.

  19. 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

  20. "Ward v. Wilbanks": Counselor Educators Respond

    ERIC Educational Resources Information Center

    Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica

    2014-01-01

    This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…

  1. Henry Ward Beecher: A Nation's Tribune.

    ERIC Educational Resources Information Center

    Chandler, Daniel Ross

    Henry Ward Beecher was America's most prominent 19th century liberal preacher and a major spokesperson for New England Transcendentalism. His philosophy integrated four fundamental themes: the creation of a moral code based on the internalization of values and peer group pressures, the establishment of the reform ideal of the impartial nonpartisan…

  2. Limits of Freedom: The Ward Churchill Case

    ERIC Educational Resources Information Center

    O'Nell, Robert M.

    2006-01-01

    The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…

  3. The nurse in a cancer ward.

    PubMed

    Sainsbury, M J; Milton, G W

    1975-12-13

    The value of discussion groups in clarifying the problems facing nurses who manage patients suffering from cancer is stressed. Nurses' responses to a questionnaire centered around the nursing of patients are examined. Some suggestions are made regarding the training of staff members who work in cancer wards.

  4. 3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW OF SOUTH FACE - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

  5. An analysis of an audit tool of ward-based practice.

    PubMed

    Field, Andrea; Reid, Brigid

    This article identifies how, in the current context of clinical governance, an audit tool of ward-based practice was developed, piloted and adopted in two acute trusts. The content of the tool is briefly outlined together with the process--the emphasis being the involvement of staff. This tool is key in assisting nurses to value essential aspects of care from the patient's perspective and to celebrate or change their practice accordingly. PMID:12216298

  6. 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…

  7. 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

  8. 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.

  9. 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

  10. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

    PubMed Central

    Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Objective Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Methods Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( χ¯ ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. Results About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76–19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05–6.19; P=0.039), age (OR =1.14; 95% CI =1.05–1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83–0.99; P=0.034). Conclusion Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

  11. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

    PubMed Central

    Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Objective Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Methods Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( χ¯ ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. Results About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76–19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05–6.19; P=0.039), age (OR =1.14; 95% CI =1.05–1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83–0.99; P=0.034). Conclusion Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls. PMID:27695303

  12. 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

  13. 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.

  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. 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

  16. 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.

  17. Reggeon-gluon vertices with Ward identities

    NASA Astrophysics Data System (ADS)

    Braun, M. A.; Vyazovsky, M. I.

    2016-03-01

    Ward identities for Reggeons are studied in the framework of an effective action approach to the QCD in Regge kinematics. It is shown that they require the introduction of new contributions not present in the Reggeon diagrams initially. Application to vertices RR →RP and RR →RRP are considered and diagrams which have to be added to the QCD ones are found.

  18. Control of infection in hospital wards

    PubMed Central

    Blowers, Robert

    1961-01-01

    Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described. Images PMID:16810967

  19. Hand decontamination practices in paediatric wards.

    PubMed

    Jelly, S; Tjale, A

    2003-12-01

    The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixty-six health professionals was obtained through convenience sampling. Results indicated that significantly fewer health professionals did not decontaminate their hands on entering the ward (16.6%), prior to making patient contact (34.8%) and prior to donning gloves (9.1%). Significantly more health professionals did decontaminate their hands following contact with the patient (63.6%) and following removal of gloves (77.8%). More health professional did not wash their hands after leaving the ward (51.5%). More than half (57.6%) of the health professionals who decontaminate their hands used the correct hand washing technique. Compliance with standard hand decontamination practices of health professionals was found to be poor with only 83.4% of health professionals decontaminating their hands at the start of work.

  20. 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.

  1. 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)

  2. 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.

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 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)

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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

  13. 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.

  14. 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…

  15. The effects of physical environments in medical wards on medication communication processes affecting patient safety.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-03-01

    Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces. PMID:24486620

  16. The effects of physical environments in medical wards on medication communication processes affecting patient safety.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-03-01

    Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces.

  17. The transition from staff nurse to ward leader.

    PubMed

    Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul

    Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it. PMID:26012049

  18. 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

  19. 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

  20. 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

  1. Monitoring Ambulation of Patients in Geriatric Rehabilitation Wards: The Accuracy of Clinicians' Prediction of Patients' Walking Time

    ERIC Educational Resources Information Center

    Cheung, Vivian H. Y.; Salih, Salih A.; Crouch, Alisa; Karunanithi, Mohanraj K.; Gray, Len

    2012-01-01

    The aim of this study is to determine whether clinicians' estimates of patients' walking time agree with those determined by accelerometer devices. The walking time was measured using a waist-mounted accelerometer device everyday during the patients' waking hours. At each weekly meeting, clinicians estimated the patients' average daily walking…

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. Ward leadership: balancing the clinical and managerial roles.

    PubMed

    Firth, Kate

    2002-04-01

    This qualitative study investigated ward managers' experiences of combining a clinical leadership role with the managerial and administrative parts of their job. Ward managers saw their main task as one of developing their staff and improving the quality of their service, yet found balancing their different roles problematic.

  11. Fibrinolytic Therapy in CCU Instead of Emergency Ward: How It Affects Door to Needle Time?

    PubMed Central

    Zeraati, Fatemeh; Homayounfar, Shahram; Esna-Ashari, Farzaneh; Khalili, Marzieh

    2014-01-01

    Background: The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU). Methods: A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. Results: The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P <0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital (P <0.01). Conclusions: The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU. PMID:24829715

  12. [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.

  13. 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

  14. 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)

  15. 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

  16. 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.

  17. [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.

  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. [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.

  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. [External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort].

    PubMed

    Tardieu, Émilie; Mahmoudi, Rachid; Novella, Jean-Luc; Oubaya, Nadia; Blanchard, François; Jolly, Damien; Dramé, Moustapha

    2016-03-01

    The aim of the study was to achieve the external validation of the SAGA instrument on the SAFES cohort. This was a prospective longitudinal multicentre cohort study, including patients aged 75 years or over, hospitalized in a short stay medical ward via emergency department. A comprehensive geriatric assessment was implemented. The psychometric validation enabled the study of feasibility, internal consistency, convergent, discriminant, and predictive validity of the instrument. The 1 306 patients of the cohort was 85±6 years, with a majority of women (65%). The completion rate of the SEGA instrument was 94%. Internal consistency was good (Cronbach alpha coefficient=0.7). Convergent validity was poor: Donini instrument (kappa=0.18; IC 95%=0.13-0.23), Rockwood instrument (kappa=0.04; IC 95%=0.02-0.06), and Winograd instrument (kappa=0.04; IC 95%=0.01-0.07). The ability of the instrument to discriminate clinically different groups was good. The SEGA instrument predicted well one-year mortality as well as one-year institution admission. Despite poor convergent validity (which is classic with frailty tools, SEGA instrument has satisfactory metrological properties, allowing its use in emergency departments and immediate post-emergency circumstances.

  5. Exploring positive hospital ward soundscape interventions.

    PubMed

    Mackrill, J; Jennings, P; Cain, R

    2014-11-01

    Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments.

  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. [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. Developing skills in clinical leadership for ward sisters.

    PubMed

    Fenton, Katherine; Phillips, Natasha

    The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

  10. Los Angeles County Poor Farm, Patient Ward Nos. 210 & ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Los Angeles County Poor Farm, Patient Ward Nos. 210 & 211 - Type B Plan, 7601 Imperial Highway; bounded by Esperanza Street, Laurel Street, Flores Street, and Descanso Street, Downey, Los Angeles County, CA

  11. Los Angeles County Poor Farm, Patient Wards 201, 202, 203, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Los Angeles County Poor Farm, Patient Wards 201, 202, 203, 204, 205, 206, 207, 208 & 209 - Type A Plan, 7601 Imperial Highway; bounded by Esperanza Street, Hawthorn Avenue, Laurel Street, and Descanso Street, Downey, Los Angeles County, CA

  12. Elevation of north facades of #156158 (triple wards) National ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Elevation of north facades of #156-158 (triple wards) - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Buildings, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

  13. Environmentalism in American Pedagogy: The Legacy of Lester Ward.

    ERIC Educational Resources Information Center

    Tanner, Laurel N.; Tanner, Daniel

    1987-01-01

    A review is presented of the legacy of Lester Frank Ward, widely recognized as the architect of environmentalism in American pedagogy and the creator of some of the most fundamental ideas about American curriculum. (CB)

  14. Three Bridge Fryer's Ford Bridge, Nimrod Bridge, and Ward's ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Three Bridge - Fryer's Ford Bridge, Nimrod Bridge, and Ward's Crossing Bridge - Fryer's Ford Bridge, Spanning East Fork of Point Remove Creek at Fryer Bridge Road (CR 67), Solgohachia, Conway County, AR

  15. 1. Streetscape of north ends of Detention Wards, Building Nos. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Streetscape of north ends of Detention Wards, Building Nos. 9946-B (left) and 9945-B (middle). Walled-in courtyard adjoins Building No. 9944-B at extreme right edge. Steam plant is in distance. This photo makes a panorama with photo WA-202-10-2. - Madigan Hospital, Detention Wards, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA

  16. 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

  17. 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.

  18. [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.

  19. 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,…

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Simonson, William; Pratt, Clara Collette

    1982-01-01

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

  2. 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.

  3. 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

  4. THE STUDY OF EFFICACY OF FAMILY WARD TREATMENT IN HYSTERIA IN COMPARISON WITH THE OPEN WARD AND THE OUTPATIENT TREATMENT

    PubMed Central

    Geetha, P. R.; Channabasavanna, S. M.; Bhatti, Ranbir S.

    1980-01-01

    SUMMARY A comparative study of the efficacy of treatment of hysterical patients is made among three group of patients—patients treated in family wards, open wards and out-patients. The number of patients is fifteen in each group and they are matched for age, sex, per capita income, duration of illness and type of illness. Significant differences among three groups on certain parameters like personality have been eliminated. The results are discussed. PMID:22058491

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. [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.

  13. 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.

  14. The Ventilation, Heating and Lighting of Hospital Wards

    PubMed Central

    Watt, James

    1933-01-01

    History of ventilation in last 100 years, showing reversal of ideas and influence of sanatorium idea. Physiology of cool moving air. How it affects metabolism, heat-loss and heat-production. Relation to sunlight. Reactive capacity of the individual. Practice of these teachings, as illustrated by sanatorium treatment of tuberculosis and by open-air schools. Exposure to cooling air a powerful therapeutic agent. Infrequent occurrence in sanatoria of diseases or complications often ascribed to cold. Dilution of infection. Applicability to diseases other than tuberculosis. Shock and old age. Perflation and diffusion, their relative values. Uniformity or variability of effect desirable? Incompatibility of good ventilation and ordinary standards of heating. Former the more important. Conclusion that ward temperatures may be lowered without harm. Measures necessary to compensate, clothing, classification of patients, small wards. Changing standards of comfort. Psychological effects. Systems of ventilation in hospital wards. Mechanical by propulsion or extraction being displaced by natural system, usually by cross-window ventilation. Supplementary ventilators. Objection to heating of incoming air. Fallibility of human factor in management. Sash versus casement windows. Hoppers. Austral window. Orientation and exposure of wards. Ventilation of small wards. Proportion of window space to solid wall. Balconies. Floor space. Heating of wards. Heating of air or floor or walls. Open fires. Value of radiant heat. Steam or water under low or high pressure. Radiators or pipes. Lighting. Avoidance of glare from windows. Arrangement of beds in wards. Colour of walls. Blinds and curtains. Artificial lighting. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:19989481

  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. [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. 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

  1. 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.

  2. Hospital admission avoidance through the introduction of a virtual ward.

    PubMed

    Jones, Joanne; Carroll, Andrea

    2014-07-01

    The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines.

  3. Protocol for an exploration of knowledge sharing for improved discharge from a mental health ward

    PubMed Central

    Rowley, Emma; Wright, Nicola; Waring, Justin; Gregoriou, Kyri; Chopra, Arun

    2014-01-01

    Introduction Strategies to reduce hospital admissions for mental health service users have received vast amounts of attention, yet the transfer of care from hospital to the community has been ignored. The discharge process is complex, messy, disjointed and inefficient, relying on cross-agency and organisational working. Focusing on one acute mental health admission ward, we will investigate whether the discharge process for people with severe mental health problems can be enhanced through the creation, implementation and utilisation of a knowledge sharing proforma that is used on their admission to the ward. Methods and analysis The project uses qualitative interviews to understand the complex processes associated with being admitted and discharged from inpatient mental health wards. Practitioners will be asked to identify and map the relevant stakeholders involved in admission and discharge, and discuss any problems with the process. The study team will work with clinicians to develop a knowledge collection proforma, which will be piloted for 2 months. Qualitative interviews will be carried out to collect reflections on the experiences of using the tool, with data used for further refinement of the intervention. Baseline and repeat quantitative measures will be taken to illustrate any changes to length of stay and readmission rates achieved as a result of the study. Ethics and dissemination A key issue is that participants are able to comment frankly on something that is a core part of their work, without fear or reprise. It is equally important that all participants are offered the opportunity to develop and coproduce the knowledge collection proforma, in order that the intervention produced is fit for purpose and usable in the real world, away from a research environment. The study has received ethical approval from Nottingham University Business School ethics committee, and has all appropriate National Health Service research governance clearances. PMID

  4. 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.

  5. 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.

  6. 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.

  7. [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

  8. 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…

  9. 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…

  10. 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…

  11. 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…

  12. 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

  13. 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…

  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. [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

  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. 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,…

  18. 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…

  19. 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…

  20. 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.…

  1. 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…

  2. 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)

  3. 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.

  4. 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

  5. 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…

  6. [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.

  7. Thermal comfort of patients in hospital ward areas.

    PubMed Central

    Smith, R. M.; Rae, A.

    1977-01-01

    The patient is identified as being of prime importance for comfort standards in hospital ward areas, other ward users being expected to adjust their dress to suit the conditions necessary for patients comfort. A study to identify the optimum steady state conditions for patients comfort is then described. Although this study raises some doubts as to the applicability of the standard thermal comfort assessment techniques to ward areas, it is felt that its results give a good indication of the steady-state conditions preferred by the patients. These were an air temperature of between 21-5 degrees and 22 degrees C and a relative humidity of between 30% and 70%, where the air velocity was less than 0-1 m/s and the mean radiant temperature was close to air temperature. PMID:264497

  8. Everyday uses of standardized test information in a geriatric setting: a qualitative study exploring occupational therapist and physiotherapist test administrators’ justifications

    PubMed Central

    2014-01-01

    Background Health professionals are required to collect data from standardized tests when assessing older patients’ functional ability. Such data provide quantifiable documentation on health outcomes. Little is known, however, about how physiotherapists and occupational therapists who administer standardized tests use test information in their daily clinical work. This article aims to investigate how test administrators in a geriatric setting justify the everyday use of standardized test information. Methods Qualitative study of physiotherapists and occupational therapists on two geriatric hospital wards in Norway that routinely tested their patients with standardized tests. Data draw on seven months of fieldwork, semi-structured interviews with eight physiotherapists and six occupational therapists (12 female, two male), as well as observations of 26 test situations. Data were analyzed using Systematic Text Condensation. Results We identified two test information components in everyday use among physiotherapist and occupational therapist test administrators. While the primary component drew on the test administrators’ subjective observations during testing, the secondary component encompassed the communication of objective test results and test performance. Conclusions The results of this study illustrate the overlap between objective and subjective data in everyday practice. In clinical practice, by way of the clinicians’ gaze on how the patient functions, the subjective and objective components of test information are merged, allowing individual characteristics to be noticed and made relevant as test performance justifications and as rationales in the overall communication of patient needs. PMID:24528609

  9. 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.

  10. 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

  11. 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

  12. “The constipation conundrum”: Improving recognition of constipation on a gastroenterology ward

    PubMed Central

    Jackson, Robert; Cheng, Philip; Moreman, Sarah; Davey, Nicola; Owen, Lisa

    2016-01-01

    Constipation is a common and often overlooked problem, but it can cause serious complications for patients including pain, nausea, urinary retention, and prolonged hospital admission. There are no recognised criteria for the diagnosis of constipation in the acute hospital setting, and it is often the role of the ward doctor to identify and manage this problem. Completion and monitoring of “stool charts” by nursing and medical staff is key to proper recognition and management of constipation. A baseline study found that while charts were completed well, they were only monitored by doctors 17.5% of the time. This quality improvement project introduced an altered “continuation sheet” to the clinical notes to prompt monitoring of stool charts and provide an area for documentation. This resulted in an increase in monitoring to 66.7%. PMID:27752319

  13. 20. West Elevation and Section, Ward 'K', Letterman General Hospital, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. West Elevation and Section, Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 2. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  14. 19. First and Second Floors. Ward 'K', Letterman General Hospital, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. First and Second Floors. Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 1. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

  15. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  16. Influence of Parental Encouragement towards Health Care of Their Wards

    ERIC Educational Resources Information Center

    Sophia, R. Grace; Veliappan, A.

    2015-01-01

    The purpose of the present study is to explore how parents are encouraging towards health care of their wards. A "Survey Method" was used in the present study. A standardized "Agarwal Parental Encouragement Scale (APES)" was used to collect information from the students. The sample consists of thousand and ninety five higher…

  17. Finding the Public in Consumer Research: A Reply to Ward.

    ERIC Educational Resources Information Center

    August, William; Charren, Peggy

    1984-01-01

    Discusses Ward's analysis of letters sent to the Federal Trade Commission about children's advertising. Advocates that public opinion research concerning consumer protection issues should include information on the degree to which consumers are informed of their fundamental rights with respect to the consumer issues being studied. (CB)

  18. Benefits of automated surface decontamination of a radioiodine ward.

    PubMed

    Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan

    2012-02-01

    A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment. PMID:22249471

  19. 2. Ramp No. 3 connection between two Standard Wards: Building ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. Ramp No. 3 connection between two Standard Wards: Building Nos. 9935-A (left) and 9934-A (right). Note asymetrical wooden door, and brick arch above doorway. - Madigan Hospital, Corridors & Ramps, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA

  20. 17. New York Connecting Railroad: Little Hell Gate Bridge. Wards ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. New York Connecting Railroad: Little Hell Gate Bridge. Wards Island, New York Co., NY. Sec. 4207, MP 8.02. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York County, NY

  1. 11. View of north side of East Ward Street midblock ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. View of north side of East Ward Street midblock between Dewey AVenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  2. 15. View of north side of East Ward Street at ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. View of north side of East Ward Street at the intersection with North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  3. 10. View of north side of East Ward Street midblock ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. View of north side of East Ward Street midblock between Dewey Avenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  4. 6. Views of southeast corner of East Ward Street and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. Views of southeast corner of East Ward Street and South Coweta Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  5. 20. View of south side of East Ward Street east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. View of south side of East Ward Street east of South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  6. 16. View of northeast corner of East Ward Street and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. View of northeast corner of East Ward Street and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  7. 12. View of south side of East Ward Street west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. View of south side of East Ward Street west of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  8. 19. View of southeast corner of East Ward Street and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. View of southeast corner of East Ward Street and South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  9. 14. View of southwest corner of East Ward Street and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. View of southwest corner of East Ward Street and South McDonald Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  10. 18. View of north side of East Ward Street at ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. View of north side of East Ward Street at the intersection with North Dart Street, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  11. 5. View of northwest corner of East Ward Street and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. View of northwest corner of East Ward Street and Dewey Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  12. 7. View of south side of East Ward Street east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. View of south side of East Ward Street east of South Coweta Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  13. 17. View of north side of East Ward Street east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. View of north side of East Ward Street east of North McDonald Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  14. 8. View of south side of East Ward Street midblock ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. View of south side of East Ward Street midblock between South Coweta Avenue and Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  15. 3. View of north side of East Ward Street midblock ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. View of north side of East Ward Street midblock between North Coweta Avenue and Dewey Avenue. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  16. 2. View of north side of East Ward Street east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. View of north side of East Ward Street east of North Coweta Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  17. 21. View of south side of East Ward Street midblock ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. View of south side of East Ward Street midblock between South McDonald Avenue and Fales Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  18. 1. View of north side of East Ward Street west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. View of north side of East Ward Street west of North Coweta Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  19. 13. View of south side of East Ward Street east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. View of south side of East Ward Street east of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  20. 4. View of north side of East Ward Street west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. View of north side of East Ward Street west of Dewey Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

  1. Maintaining connections: some thoughts on the value of intensive care unit rounding for general medicine ward teams.

    PubMed

    Howell, Joel D

    2011-09-01

    When established ward patients are unexpectedly transferred to an intensive care unit (ICU), the ward team should continue to follow them. Although there may be reasons not to do so, the advantages outweigh the obstacles. Great pedagogic value can be gained from following patients after acute decompensation, but a more important reason is that by following patients into the ICU, the ward team can enact for both patients and their families the twin virtues of caring and continuity. Doing so also demonstrates the highest ideals of medicine-that we are focused not on defined areas of turf, but on our patient's well-being. It shows that we are not merely doing narrowly defined "shift work," but that we truly care about our patients. Rounding on established patients who have been transferred into the ICU is the sort of behavior that undergirds the fundamental bases of professionalism. It takes a few minutes from a busy day, but it can be incredibly beneficial for families, patients, and the ideals of medicine.

  2. [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

  3. Antipsychotic effect of milieu in the acute treatment of schizophrenia.

    PubMed

    Cohen, S; Khan, A

    1990-07-01

    We studied 35 patients meeting DSM-III criteria for schizophrenia, paranoid or undifferentiated type, chronic with acute exacerbation. All were treated in hospital, 13 on a psychiatric intensive care unit, and 22 on an open ward. The former unit is a more structured and less stimulating one. We found those patients treated on that ward to show greater improvement in BPRS ratings during the first 2 days of hospitalization compared to the open-ward group, despite similar doses of medication being utilized. Additionally, this improvement was noted to occur among BPRS items comprising a psychotic subscale.

  4. 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

  5. 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.

  6. [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.

  7. 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.

  8. 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

  9. 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

  10. [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.

  11. 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.

  12. 75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... AGENCY Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements AGENCY... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina for publication. DATES... your comments, identified by Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward...

  13. 78 FR 14543 - Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

    ... AGENCY Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement AGENCY... Agency has entered into a settlement at the Ward Transformer Superfund Site located in Raleigh, Wake... EPA Region 4 contact Ms. Paula V. Painter. Submit your comments by Site name Ward...

  14. Youth Health Coordinating Council Ward 8 Secret Health Clinic Shopper Report

    ERIC Educational Resources Information Center

    Behrens, Donna

    2010-01-01

    There are over 70,000 residents in Ward 8, the poorest area of Washington, DC and along with Ward 7, it's most geographically remote. Approximately 36% of the Ward 8 population consists of children and youth, 18 years or younger. Children in the District of Columbia are at greater risk for poorer health and life outcomes than children in other…

  15. 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.

  16. 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.

  17. 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

  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. 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

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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

  5. Ward identities in a general axial gauge. II. Quantum gravity

    SciTech Connect

    Capper, D.M.; Leibbrandt, G.

    1982-02-15

    We have calculated the pole part of the one-loop graviton self-energy in the noncovariant axial gauge n/sub ..mu../phi/sub munu/ = 0, n/sup 2/not =0, where phi/sub munu/ is the physical graviton field and n/sub ..mu../ is an arbitrary but constant vector. It is shown that the self-energy is, unexpectedly, both nontransverse and n/sub ..mu../ dependent, even though it satisfies the correct gravitational Ward identity. This Ward identity is found to contain a term corresponding to a ''pincer'' Feynman diagram which is directly responsible for the nontransversality of the graviton self-energy. Ghost particles do not contribute to the graviton amplitude. All axial-gauge integrals are consistently evaluated in the context of dimensional regularization and by applying the principal-value prescription.

  6. Ward identities in a general axial gauge. II. Quantum gravity

    NASA Astrophysics Data System (ADS)

    Capper, D. M.; Leibbrandt, George

    1982-02-01

    We have calculated the pole part of the one-loop graviton self-energy in the noncovariant axial gauge nμφμν=0, n2≠0, where φμν is the physical gravition field and nμ is an arbitrary but constant vector. It is shown that the self-energy is, unexpectedly, both nontransverse and nμ dependent, even though it satisfies the correct gravitational Ward identity. This Ward identity is found to contain a term corresponding to a "pincer" Feynman diagram which is directly responsible for the nontransversality of the graviton self-energy. Ghost particles do not contribute to the graviton amplitude. All aixal-gauge integrals are consistently evaluated in the context of dimensional regularization and by applying the principal-value prescription.

  7. Effects and impacts of Productive Ward from a nursing perspective.

    PubMed

    White, Mark; Waldron, Michelle

    The Productive Ward: releasing time to care (PW) initiative is predominantly a nurse-led quality improvement (QI) offering, designed to streamline ward work processes and clinical environments in an attempt to 'release time to care'. It has been implemented widely in the UK, recently attracting international interest. This paper systematically reviews the literature relating to the PW initiative, highlights and ranks the reported effects and impacts from a nursing perspective. Nine themes emerged from our content analysis. This paper examines the three most reported themes-empowerment, leadership and engagement-exploring how they may influence the opportunities for implementing and sustaining the initiative. This study brings some experience, learning and insight from the PW initiative to those currently involved in implementation. It also highlights some elements of change not being delivered by PW. The comprehensive list of reported impacts and effects, from a nursing perspective, adds value to senior nurses attempting to cultivate a culture of QI.

  8. Ward identities and relations between conductivities and viscosities in holography

    NASA Astrophysics Data System (ADS)

    Hoyos, Carlos; Fernández, David Rodríguez

    2016-01-01

    We derive relations between viscosities and momentum conductivity in 2 + 1 dimensions by finding a generalization of holographic Ward identities for the energy-momentum tensor. The generalization is novel in the sense that it goes beyond the usual identities obtained from holographic renormalization. Our results are consistent with previous field theory analysis. The main tools we use are a constant `probability current' in the gravity dual, that we are able to define for any system of linear ODEs, and parity symmetry.

  9. 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

  10. 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.

  11. Midwifery students first encounter with the maternity ward.

    PubMed

    Thunes, Sissel; Sekse, Ragnhild Johanne Tveit

    2015-05-01

    Considerable research has been made in order to find what promotes students' learning in general, but few studies have included midwifery students and their learning in clinical practice. The purpose of this study was to get a better understanding of the midwifery students' first encounter with the maternity ward and of what was essential to them in the learning environment. A qualitative study, based on in-depth interviews with six students during their first clinical practice at a maternity ward, was conducted. The findings show that the students needed to feel their presence desired and to be included in the activities in the ward. Learning needed to be based on the students' expectations, understanding and previous experiences. The most important factor influencing the students' well-being and learning was their relationships with their mentor. In conclusion, learning in a clinical setting required more than just motivated students. Engaged mentors, who linked the students' previous experiences and expectations to the clinical practice, were crucial to learning outcomes. Mutual engagement, shared understanding and common goals were imperative for the students' experiences of a good learning environment. PMID:25701290

  12. The Use of Smartphones on General Internal Medicine Wards

    PubMed Central

    Morra, D.; Lo, V.; Quan, S.; Wu, R.

    2014-01-01

    Summary Objective To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use. Methods A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys. Results Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity. Conclusion Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians. PMID:25298819

  13. Medical academia clinical experiences of Ward Round Teaching curriculum

    PubMed Central

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858

  14. Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review

    PubMed Central

    van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.

    2015-01-01

    Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future

  15. How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes toward Geriatric Care

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.

    2009-01-01

    Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the…

  16. 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…

  17. 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…

  18. 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

  19. 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…

  20. 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…

  1. 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…

  2. 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…

  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. 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…

  5. [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

  6. 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…

  7. 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...

  8. 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...

  9. 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...

  10. 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…

  11. [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.

  12. 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…

  13. 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.…

  14. 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…

  15. 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…

  16. 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…

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. [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

  12. 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

  13. 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

  14. 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

  15. 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.

  16. 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.

  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. Ward identities and chiral anomalies for coupled fermionic chains

    SciTech Connect

    Costa, L. C.; Ferraz, A.; Mastropietro, Vieri

    2013-12-15

    Coupled fermionic chains are usually described by an effective model written in terms of bonding and anti-bonding fermionic fields with linear dispersion in the vicinities of the respective Fermi points. We derive for the first time exact Ward Identities (WI) for this model, proving the existence of chiral anomalies which verify the Adler-Bardeen non-renormalization property. Such WI are expected to play a crucial role in the understanding of the thermodynamic properties of the system. Our results are non-perturbative and are obtained analyzing Grassmann functional integrals by means of constructive quantum field theory methods.

  19. 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.

  20. 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

  1. Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?

    PubMed

    Devine, J; Cooke, R P; Wright, E P

    2001-05-01

    A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact.

  2. Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?

    PubMed

    Devine, J; Cooke, R P; Wright, E P

    2001-05-01

    A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact. PMID:11358473

  3. 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

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

    PubMed

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

    2012-04-01

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

  5. 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

  6. [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.

  7. 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

  8. 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.

  9. Where does research occur in geriatrics and gerontology?

    PubMed

    Navarro, Albert; Lynd, Frances E

    2005-06-01

    The International Plan of Action on Aging 2002 emphasized the need to promote and develop research on aging, especially in underdeveloped countries. This article aims at describing the current situation with regard to the international scientific production in the field of geriatrics and gerontology. All articles published in journals included in the categories "Geriatrics and Gerontology" of the Science Citation Index or "Gerontology" of the Social Science Citation Index in 2002 were analyzed. There is unquestionable predomination by the United States, which participates in 53.8% of the articles analyzed, followed by the United Kingdom (9.66%) and Canada (6.66%). The production of the 15 European Union countries together is 31.2%. When adjustments are made for economic or population factors, other countries show their importance: Israel and Sweden, for example. Authors from richer countries participate in more than 95% of the articles, whereas those in less-developed countries tend to publish less, and when they do so, it is through collaboration with more-developed countries. In general, only 10.5% of the articles are written in collaboration with institutions from different countries. One of the keys to stimulating research in less wealthy countries would seem to be precisely through collaboration. This would aid the transfer of knowledge and experience, allowing researchers in these countries to obtain autonomy to perform their own studies independently and to provide them with the ability to gain access for their publications at the international level.

  10. Effectiveness of a Web-Based Simulation in Improving Nurses’ Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

    PubMed Central

    Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim

    2016-01-01

    Background Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting. Objective The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. Methods A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. Results The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The

  11. 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

  12. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

    PubMed Central

    Driesen, Babiche E. J. M.; Merten, Hanneke; Ludikhuize, Jeroen; van der Spoel, Johannes I.; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.

    2016-01-01

    Background An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU. Methods Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system. Results Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record. Conclusions This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted. PMID:27537689

  13. Hospital Acquired Pneumonia Due to Achromobacter spp. in a Geriatric Ward in China: Clinical Characteristic, Genome Variability, Biofilm Production, Antibiotic Resistance and Integron in Isolated Strains

    PubMed Central

    Liu, Chao; Pan, Fei; Guo, Jun; Yan, Weifeng; Jin, Yi; Liu, Changting; Qin, Long; Fang, Xiangqun

    2016-01-01

    Background: Hospital-acquired pneumonia (HAP) due to Achromobacter has become a substantial concern in recent years. However, HAP due to Achromobacter in the elderly is rare. Methods: A retrospective analysis was performed on 15 elderly patients with HAP due to Achromobacter spp., in which the sequence types (STs), integrons, biofilm production and antibiotic resistance of the Achromobacter spp. were examined. Results: The mean age of the 15 elderly patients was 88.8 ± 5.4 years. All patients had at least three underlying diseases and catheters. Clinical outcomes improved in 10 of the 15 patients after antibiotic and/or mechanical ventilation treatment, but three patients had chronic infections lasting more than 1 year. The mortality rate was 33.3% (5/15). All strains were resistant to aminoglycosides, aztreonam, nitrofurantoin, and third- and fourth-generation cephalosporins (except ceftazidime and cefoperazone). Six new STs were detected. The most frequent ST was ST306. ST5 was identified in two separate buildings of the hospital. ST313 showed higher MIC in cephalosporins, quinolones and carbapenems, which should be more closely considered in clinical practice. All strains produced biofilm and had integron I and blaOXA-114-like. The main type was blaOXA-114q. The variable region of integron I was different among strains, and the resistance gene of the aminoglycosides was most commonly inserted in integron I. Additionally, blaPSE-1 was first reported in this isolate. Conclusion: Achromobacter spp. infection often occurs in severely ill elders with underlying diseases. The variable region of integrons differs, suggesting that Achromobacter spp. is a reservoir of various resistance genes. PMID:27242678

  14. [Initial epidemiological data on the clinical effects in health workers employed in the manual lifting of patients in wards].

    PubMed

    Colombini, D; Riva, F; Luè, D; Nava, C; Petri, A; Basilico, S; Linzalata, M; Morselli, G; Cotroneo, L; Ricci, M G; Menoni, O; Battevi, N

    1999-01-01

    An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3341 health workers whose job involved manual handling of patients (553 male and 2788 females, 1568 working in hospitals and 1773 in geriatric residences). Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. The sample analyzed may be considered as representative of the situation in hospitals in Italy, at least for northern and central Italy. The mean age was 36 years, mean length of service in the department 6 years and mean length of job duration not exceeding 10 years; staff turnover was high. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. Also in the case of clinical-functional spondyloarthropathies of the lumbosacral spine, in the females there was a significantly higher prevalence than in the reference groups. All disorders were more severe in sectors more at risk, i.e., old peoples homes, rehabilitation centres, orthopaedic and surgical departments, and in any case higher in old peoples homes and geriatric residences. The initial data concerning the ratio between presence of spinal disease and risk index were also positive.

  15. 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

  16. 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.

  17. 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

  18. The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward.

    PubMed

    Moore, Ginny; Muzslay, Monika; Wilson, A Peter R

    2013-05-01

    OBJECTIVE. To investigate the distribution of hospital pathogens within general and critical care ward environments and to determine the most significant bacterial reservoirs within each ward type. DESIGN. Prospective 4-month microbiological survey. SETTING. The intensive care unit (ICU) and gastrointestinal (GI) surgical ward of a London teaching hospital. PATIENTS. Sampling was conducted in and around the bed space of 166 different patients (99 in the ICU and 67 in the GI ward). METHODS. Conventional agar contact methodology was used to sample 123 predetermined sites twice a week for 17 weeks. Sixty-one surfaces were located within the ICU, and 62 were located within the GI ward. Each surface was located within a theoretical zone of increasing distance from the patient. Aerobic colony counts were determined, and confirmatory testing was conducted on all presumptive pathogens. RESULTS. Regardless of ward type, surfaces located closest to the patient, specifically those associated with the bed (side rails, bed control, and call button), were the most heavily contaminated. Elsewhere, the type of surfaces contaminated differed with ward type. In the ICU, bacteria were most likely to be on surfaces that were regularly touched by healthcare workers (e.g., telephones and computer keyboards). In the GI ward, where the patients were mobile, the highest numbers of bacteria (including potential nosocomial pathogens) were on surfaces that were mainly touched by patients, particularly their toilet and shower facilities. CONCLUSIONS. In terms of cleaning, a hospital should not be considered a single entity. Different ward types should be treated as separate environments, and cleaning protocols should be adjusted accordingly.

  19. How Can Ward Teaching Be Made More Systematic?

    PubMed

    2016-09-01

    : Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month's article, from the June 1926 issue, offers ideas "by which we hope to make ward experiences of more value to the student." Author Mina A. McKay originally presented this material at a meeting of the Massachusetts State League of Nursing Education. She calls for more comprehensive morning and evening reports ("not just a mere reading of… orders"), the use of student experience records, ward clinics ("the type of bedside talk which supplements class room lectures"), and case reports presented by the students themselves. Efforts to improve clinical nursing education are ongoing, and in "'Flipping' the Classroom" in this month's AJN, Diane M. Billings describes a relatively new way of translating clinical concepts into practice.

  20. How Can Ward Teaching Be Made More Systematic?

    PubMed

    2016-09-01

    : Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month's article, from the June 1926 issue, offers ideas "by which we hope to make ward experiences of more value to the student." Author Mina A. McKay originally presented this material at a meeting of the Massachusetts State League of Nursing Education. She calls for more comprehensive morning and evening reports ("not just a mere reading of… orders"), the use of student experience records, ward clinics ("the type of bedside talk which supplements class room lectures"), and case reports presented by the students themselves. Efforts to improve clinical nursing education are ongoing, and in "'Flipping' the Classroom" in this month's AJN, Diane M. Billings describes a relatively new way of translating clinical concepts into practice. PMID:27560341

  1. Self-destructive behavior on an inpatient ward.

    PubMed

    Kroll, J L

    1978-06-01

    Suicidal and self-destructive behavior on a psychiatric inpatient service are said to be related to the degree of staff demoralization and dissension. Staff factors that may permit or encourage self-destructive acts include poor communications, staff disagreements, scapegoating of patients, poor staff judgment, staff self-preoccupation, and reversal of staff-patient roles. However, it is also possible that a major contributory factor is not individual patient or staff psychopathology, but rather the destruction of the underlying traditions and values of the ward which occurs at times of major change. The thesis is presented that the ritualization of ward values, when operative, provides a coherent world-view which renders the therapeutic activities, and life itself, meaningful, and that such ritualization can provide a framework of stability in times of critical staff turnover. Without such tradition and ritualization, however, therapeutic activities become hollow and meaningless, and fail to provide self-destructive patients a reason to view their life more positively.

  2. Perceptions of nursing students trained in a new model teaching ward in Malawi.

    PubMed

    Bvumbwe, Thokozani

    2015-01-01

    This study aimed to investigate the perceptions of nursing students trained in a new model teaching ward in Malawi. A total of 90students from five nursing colleges were randomly assigned to one model ward and two ordinary wards in a single teaching hospital. The students were administered a revised version of the Student Evaluation of Clinical Education Environment questionnaire. Significant differences among the three wards were found in all items in the communication/feedback subscale, with the exception of the item "nursing staff provided constructive feedback" (P=0.162). Within the learning opportunities subscale all items showed significant differences among the three wards, whereas 50% of the items in the learning support/assistance subscale had significantly different responses among the three wards. Within the department atmosphere subscale, no significant differences were found in the items assessing whether an adequate number and variety of patients were present in the ward (P=0.978). The strategies that are being implemented to improve the educational environment showed positive results. Students scored the model teaching ward highly. Students who underwent precepting in the model teaching wards reported having more learning opportunities and a positive learning environment. PMID:26639604

  3. Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

    NASA Astrophysics Data System (ADS)

    Lurkittikul, N.; Kittithreerapronchai, O.

    2014-06-01

    The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.

  4. 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

  5. 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.

  6. 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.

  7. [Oral rehydration in acute gastroenteritis in infants and children--advantages of a standardized protocol].

    PubMed

    Weizman, Z; Weizman, A; Alsheikh, A; Herzog, L; Tal, A; Gorodischer, R

    2000-11-01

    Oral rehydration (OR) for acute gastroenteritis in infants and children has been shown to be as effective as IV therapy, with less discomfort and lower costs. In this retrospective study we compared 2 pediatric wards, in 1 of which only a standardized, simplified, bedside protocol, based on American Academy of Pediatrics guidelines, was used. There were no significant clinical characteristics in the 208 patients. In the ward which used the above protocol, OR utilization was significantly more frequent than in the other ward (48% versus 15%), thus saving equipment costs of nearly $1,000/3 months. There were no significant differences in outcome between the wards. We conclude that introducing a standardized management protocol may increase OR utilization in hospitalized children with acute diarrhea. PMID:11341212

  8. Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

    PubMed

    Doherty, Tanya; Kroon, Max; Rhoda, Natasha; Sanders, David

    2016-07-01

    South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more.

  9. Geriatric medicine training for family practice residents in the 21st century: a report from the Residency Assistance Program/Harfford Geriatrics Initiative.

    PubMed

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

    2003-01-01

    Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. With support from the John A. Hartford Foundation of New York City, the American Academy of Family Physicians (AAFP) implemented in 1995 a multi-part project to improve the amount and quality of geriatric medicine education received by family practice residents. This report summarizes the initial results of the regional geriatric medicine curriculum retreats for residency directors. The goals of the retreats were to build recognition among the residency directors of the skills that future family physicians will require to be successful providers of primary care to older adults and to allow the residency directors to identify and develop solutions to barriers to improving geriatric medicine training for residents. Forty-six program directors participated in the three retreats between February 2000 and February 2001. The participants represented 52 programs and rural tracks in all geographic regions, small and large programs, and urban and rural settings. The program directors developed a consensus on the geriatric medicine knowledge, skills, and attitudes that should be expected of all family practice residency graduates; developed a list of basic, required educational resources for each family practice residency program; and proposed solutions to common obstacles to successful curriculum development.

  10. 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

  11. Epidemiological study by pulsed-field gel electrophoresis of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a geriatric hospital.

    PubMed Central

    Gouby, A; Neuwirth, C; Bourg, G; Bouziges, N; Carles-Nurit, M J; Despaux, E; Ramuz, M

    1994-01-01

    Twelve cases of infections caused by extended-spectrum beta-lactamase (ESBla)-producing Klebsiella pneumoniae were reported between August 1991 and March 1993 in the Geriatric Department of the Nimes University Hospital, where these bacterial had not been previously isolated. Restriction profiles of total genomic DNAs cleaved by XbaI and SpeI were compared by pulsed-field gel electrophoresis. The strains that were tested included the 12 isolates from K. pneumoniae-infected patients, strains recovered from rectal swabs of asymptomatic patients in the same ward, and strains isolated in other hospitals in Nîmes at the same time. The restriction profiles of the 12 isolates and those recovered from asymptomatic patients in the same ward were very similar. Over a period of more than 1 year, extended-spectrum beta-lactamases were not detected in K. pneumoniae isolates with restriction patterns different from that of the epidemic strain. It seems, therefore, that there was no transfer of a plasmid or a gene coding for ESBla to strains of K. pneumoniae that were different from the epidemic strain. At the same time, ESBla-producing K. pneumoniae isolates exhibiting restriction endonuclease profiles very different from that of the epidemic strain were isolated from other hospitals in Nîmes. None of these strains caused an outbreak. Pulsed-field gel electrophoresis, which allows precise characterization of strains beyond the species level, is a useful tool for studying the ESBla-producing K. pneumoniae strains involved in nosocomial outbreaks. Images PMID:8150938

  12. 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.

  13. [Presbyastasis and application of vestibular rehabilitation in geriatrics].

    PubMed

    Costa de Araujo, P; Demanez, L; Lechien, J; Bauvir, P; Petermans, J

    2011-03-01

    Balance disorders can have a major functional impact among the elderly. The main risk is falling. Three elements are implicated in the loss of balance: vision, proprioception and the vestibular system. This article will discuss mainly vestibular damage and its implications. The assessment of balance disorders, particularly in geriatric patients, is based on validated scales composed of several items. These provide scores and are based on the results of chronometric measurements. They can be useful for the application of Vestibular Rehabilitation (VR), a technique improving the adaptation and autonomy of these patients. Vestibular rehabilitation is therefore part of an overall support, the goal of therapy being to improve daily life and to reduce the risk of falls. PMID:21560428

  14. [Comprehensive geriatric assessment in older patients with diabetes mellitus].

    PubMed

    Araki, Atsushi

    2013-11-01

    Because the prevalence of older old patients with diabetes is increasing in Japan, diabetic patients with physical or cognitive impairment are also becoming to be more prevalent in clinical practice. The comprehensive geriatric assessment (CGA) consists of 5 important domains: physical function (basic ADL, instrumental ADL, vision, etc.), psychological function, mental function, socio-economic conditions, and patient's preference. The functions in CGA can be used as predictors for prognosis, a tool for early diagnosis of dementia, assessment tool of patient's capacity for insulin self-injection, and outcomes of diabetes treatment. The CGA is also useful in performing a patient-centered approach to improve the physical, psychological, and mental functions as well as to individualize a treatment goal of HbA1c in elderly patients with diabetes mellitus.

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

    PubMed

    Zhou, D H

    1982-01-01

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

  16. Subtle ethical dilemmas in geriatric management and clinical research.

    PubMed

    Rosin, A J; van Dijk, Y

    2005-06-01

    Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person's privacy. Attending a day centre confers much benefit, but one must understand the old person's resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person's competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated. PMID:15923486

  17. Geriatric profile of Thomas Jefferson (1743-1826).

    PubMed

    Sherman, E D

    1977-03-01

    This geriatric profile specifically reflects the impressive achievements of Thomas Jefferson during the years of his retirement (ages 66-83) following a distinguished political career culminating in the Presidency. President Monroe sought his advice even after the age of 80, and Jefferson's reasoning was instrumental in the formulation of the Monroe Doctrine. Education was a foremost priority in retirement. He was responsible for the establishment of the University of Virginia, in which his versatility was manifested as architect, builder, and fund raiser. Jefferson was a man of breadth and extraordinary vision for his time, and has come to be known as the "Father of American Democracy." The basic concepts of his philosophy, including the realm of aging, remain valid today-150 years after his passing.

  18. 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

  19. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects].

    PubMed

    Belin, J; Houéto, J L; Constans, T; Hommet, C; de Toffol, B; Mondon, K

    2015-12-01

    Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects. PMID:26573332

  20. Recent Advances in Neuroimaging Biomarkers in Geriatric Psychiatry

    PubMed Central

    Khandai, Abhisek C.; Aizenstein, Howard J.

    2013-01-01

    Neuroimaging, both structural and functional, serve as useful adjuncts to clinical assessment, and can provide objective, reliable means of assessing disease presence and process in the aging population. In the following review we briefly explain current imaging methodologies. Then, we analyze recent developments in developing neuroimaging biomarkers for two highly prevalent disorders in the elderly population- Alzheimer's disease (AD) and late-life depression (LLD). In AD, efforts are focused on early diagnosis through in vivo visualization of disease pathophysiology. In LLD, recent imaging evidence supports the role of white matter ischemic changes in the pathogenesis of depression in the elderly, the “vascular hypothesis.” Finally, we discuss potential roles for neuroimaging biomarkers in geriatric psychiatry in the future. PMID:23636984

  1. 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.

  2. [Geriatric Depression Scale as auxiliary diagnostic tool used in patients 55 years and older].

    PubMed

    Bidzan, Leszek; Łapin, Joanna; Sołtys, Krzysztof; Turczyński, Jacek

    2002-01-01

    The purpose of this study was to examine the Geriatric Depression Scale translated into Polish for its sensitivity and specificity in relation to obligatory criterions ICD-10. 208 at random select patients from Psychiatry Department and Psychiatry Clinic were included into study. Diagnosis was based on ICD 10 criteria. Geriatric Depression Scale were used in full version containing 30 of questions directed to examined (self-rating). Each questions was read to examined persons. At last 185 persons were included to statistical analysis's. Sensitivity and specificity obtained for critical value equal or higher from 11 points, were 81% and 47% Geriatric Depression Scale is useful tool in initial diagnosis of depression in older people. However one should be clearly to underline, that investigation with Geriatric Depression Scale should start diagnostic process, never while to take place full psychiatric investigations. PMID:12647438

  3. Using collaboration to maximize outcomes for a John A. Hartford Foundation geriatric enrichment project.

    PubMed

    Fromm Faria, Debra; David, Virginia V; Dauenhauer, Jason; Dwyer, Diane

    2007-01-01

    Two institutions representing two BSW and one MSW program and a geriatric education center collaborated in a John A. Hartford geriatric enrichment project. Sharing the risks and benefits of a collaborative model, 75 percent of faculty participated in mini faculty fellowships, and bi-monthly dinner meetings with colleagues from each of the three programs, and actively engaged in the curricula revisions. Faculty report pervasive geriatric enrichment in each program's foundation content areas, and increases in students placed in geriatric enriched field practicum settings, from pre-project levels of 8.1 percent to a high of 24 percent. The features of the collaborative project include: respecting each program's autonomy while actively sharing ideas, resources and partnering with community's aging experts; and strengthening mutually reciprocal relationships among faculty and the gerontologic practice community. This model of shared risks and benefits also provides opportunities for innovation, diverse thinking, and shared decision making.

  4. 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

  5. Preparing Social Work Students for Interprofessional Practice in Geriatric Health Care: Insights from Two Approaches

    ERIC Educational Resources Information Center

    Bonifas, Robin P.; Gray, Amanda K.

    2013-01-01

    Although several interprofessional education projects have addressed training allied health students for effective teamwork in geriatrics, few curriculum evaluation studies have examined differences in learning outcomes between interprofessional and traditional uniprofessional approaches, especially for social work students. This paper compares…

  6. Assessing health status and outcomes in a geriatric day hospital.

    PubMed

    Fowler, R W; Congdon, P; Hamilton, S

    2000-11-01

    The study objective was to assess the feasibility and usefulness of recommended outcome measures in older people attending a geriatric day hospital for multidisciplinary assessment and rehabilitation. We used the 'Short Form 36' (SF36) questionnaire which had been proposed as a suitable outcome tool for the elderly, as well as standard assessment scales (eg Barthel index). These were administered by interviewers at the start of day hospital attendance and repeated by postal survey three and six months later. Change in overall health status was rated by the clinical team. The study took place in a geriatric day unit based in a support hospital, specialising in assessment and rehabilitation of older people. Participants were older people referred directly from the community, or following an inpatient day, whose assessment indicated a need for multidisciplinary rehabilitation. Stroke and musculo-skeletal disorders were the commonest underlying conditions. There was a high incidence of non-completion on SF36 questions relating to physical and mental function. Subsequent interviews showed that patients found some questions irrelevant. Floor effects were common. In contrast, the standard scales were invariably fully completed. Compared with local population survey data, respondents had low baseline scores on all SF36 dimensions. Differences over time were probably explained by varying methods of administration. In spite of a clinical perception of improved health status during day hospital attendance, both standard and SF36 scores showed overall deterioration. Two conclusions could be drawn from this study. 1. Measures of physical and mental disability and quality of life gave lower results than expected and continued declining over a six month period, even when the clinical team felt that the patient had improved. 2. Administration of SF36 by an interviewer is essential to obtain meaningful results in older people with poor physical health, which should be interpreted

  7. Geriatric High-Energy Polytrauma With Orthopedic Injuries

    PubMed Central

    Abdelfattah, Adham; Core, Michael Del; Watson, J. Tracy

    2014-01-01

    Background: The impact of orthopedic injuries in the elderly patient with multi-trauma and the effect of operative fixation on these injuries have not been thoroughly evaluated. Methods: We reviewed geriatric patients (aged 65 and older) between 2004 and 2010 at a level 1 trauma center who sustained high-energy polytrauma (injury and severity score [ISS] ≥ 16) with associated orthopedic injuries. Patients were excluded if they had severe head and spine injuries, died on arrival, or had low-energy mechanisms of injury. Logistic regression was conducted to identify factors that predict mortality. Results: There were 154 patients who comprised our study group with an average age of 76 years and an ISS of 23. There were 96 males and 58 females. Overall, 52 patients died within 1 year of their admission: 21 patients during their initial hospital stay and 31 patients within 1 year following admission. In all, 64 (42%) patients underwent operative stabilization of their orthopedic injuries. Increased mortality was seen (P < .05) in female patients, those with lower admission Glasgow coma score, and those who underwent orthopedic surgery. Patients had worse outcomes if they sustained femur (P = .014), clavicle, or scapular fractures (P = .027). Other factures associated with higher mortality included pelvic/acetabular injury requiring surgery (P = .019) or spine fractures treated nonoperatively (P = .014). Conclusion: The effect of orthopedic injuries on this geriatric polytrauma group contribute to worse outcomes when they included clavicle, scapula, and femur fractures. We also found that pelvic/acetabular fractures treated operatively and nonoperative spine fractures were associated with higher mortality rates. Risk/benefit consideration is suggested when contemplating operative intervention in these patients. PMID:26246939

  8. [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

  9. A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7.

    PubMed

    Kim, Jin Won; Kim, Se-Hyun; Kim, Yu Jung; Lee, Keun-Wook; Kim, Kwang-Il; Lee, Jong Seok; Kim, Cheol-Ho; Kim, Jee Hyun

    2015-01-01

    Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92-0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85-0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73-0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention. PMID:26401951

  10. A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7

    PubMed Central

    Kim, Jin Won; Kim, Se-Hyun; Kim, Yu Jung; Lee, Keun-Wook; Kim, Kwang-Il; Lee, Jong Seok; Kim, Cheol-Ho; Kim, Jee Hyun

    2015-01-01

    Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92−0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85–0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73−0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention. PMID:26401951

  11. Clinical ethics ward rounds: building on the core curriculum.

    PubMed

    Parker, Lisa; Watts, Lisa; Scicluna, Helen

    2012-08-01

    The clinical years of medical student education are an ideal time for students to practise and refine ethical thinking and behaviour. We piloted a new clinical ethics teaching activity this year with undergraduate medical students within the Rural Clinical School at the University of New South Wales. We used a modified teaching ward round model, with students bringing deidentified cases of ethical interest for round-table discussion. We found that students were more engaged in the subject of clinical ethics after attending the teaching sessions and particularly appreciated having structured time to listen to and learn from their peers. Despite this, we found no change in student involvement in managing or planning action in situations that they find ethically challenging. A key challenge for educators in clinical ethics is to address the barriers that prevent students taking action.

  12. Evaluation of the California Youth Authority Ward Grievance Procedure. Final Report.

    ERIC Educational Resources Information Center

    EMT Associates, Inc., Sacramento, CA.

    This document presents the findings and recommendations of the evaluation of the California Department of the Youth Authority Ward Grievance Procedure (WGP), which is a four-tiered conflict resolution system for wards in California institutions and camps. The information contained in this report was obtained through site visits to five…

  13. Creating Readers: Vonda Ward--Broward County Library, Fort Lauderdale, FL

    ERIC Educational Resources Information Center

    Library Journal, 2004

    2004-01-01

    This article details the work of Vonda Ward--a middle-school teacher turned librarian. When Vonda Ward was a middle-school teacher, she could not get her students to share her excitement about history because they could not read its stories. That is when she realized how much subject mastery depended on the basics. Broward County Library's leaders…

  14. Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward

    ERIC Educational Resources Information Center

    Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

    2013-01-01

    Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

  15. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott

    2014-07-01

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing. PMID:24890806

  16. Occupational health for an ageing workforce: do we need a geriatric perspective?

    PubMed Central

    Koh, Gerald Choon-Huat; Koh, David

    2006-01-01

    Extending retirement ages and anti-age discrimination policies will increase the numbers of older workers in the future. Occupational health physicians may have to draw upon the principles and experience of geriatric medicine to manage these older workers. Examples of common geriatric syndromes that will have an impact on occupational health are mild cognitive impairment and falls at the workplace. Shifts in paradigms and further research into the occupational health problems of an ageing workforce will be needed. PMID:16722617

  17. Impairment in Instrumental Activities of Daily Living and the Geriatric Syndrome of Self-Neglect

    PubMed Central

    Naik, Aanand D.; Burnett, Jason; Pickens-Pace, Sabrina; Dyer, Carmel B.

    2010-01-01

    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 community geriatrics clinic. We made our assessments by using two manual muscle tests, a timed-gait test, a modified Physical Performance Test (mPPT), and the Kohlman Evaluation of Living Skills (KELS). Results Participants in the self-neglect group had impaired mPPT (p < .077) and KELS (p < .001) scores compared with community-controls. Using analysis of covariance models, we found that self-neglect referral explained a significant proportion of the variance in KELS scores (32%; p < .001) but not in mPPT scores (22%; p = .49). Implications The geriatric syndrome of self-neglect is associated with increased morbidity and mortality and appears to be independently associated with impairments in instrumental activities of daily living. The evaluation and treatment of geriatric self-neglect should be consistent with that of other geriatric syndromes. PMID:18591364

  18. 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

  19. 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.

  20. Loss of olfactory function and nutritional status in vital older adults and geriatric patients.

    PubMed

    Toussaint, Nicole; de Roon, Margot; van Campen, Jos P C M; Kremer, Stefanie; Boesveldt, Sanne

    2015-03-01

    The aim of this cross-sectional study was to assess the association of olfactory function and nutritional status in vital older adults and geriatric patients. Three hundred forty-five vital (mean age 67.1 years) and 138 geriatric older adults (mean age 80.9 years) were included. Nutritional status was assessed using the mini nutritional assessment-short form. The Sniffin' Sticks was used to measure olfactory function. Eleven percentage of the vital older adults were at risk of malnutrition, whereas 60% of the geriatric participants were malnourished or at risk. Only 2% of the vital older adults were anosmic, compared with 46% of the geriatric participants. Linear regression demonstrated a significant association (P = 0.015) between olfactory function and nutritional status in the geriatric subjects. However, this association became insignificant after adjustment for confounders. Both crude and adjusted analysis in the vital older adults did not show a significant association. The results indicate that, in both groups of elderly, there is no direct relation between olfactory function and nutritional status. We suggest that a decline in olfactory function may still be considered as one of the risk-factors for malnutrition in geriatric patients-once co-occurring with other mental and/or physical problems that are more likely to occur in those patients experience.

  1. Locked doors in acute inpatient psychiatry: a literature review.

    PubMed

    van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K

    2009-04-01

    Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.

  2. Locked doors in acute inpatient psychiatry: a literature review.

    PubMed

    van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K

    2009-04-01

    Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry. PMID:19291159

  3. Orthopaedic inpatient rehabilitation conducted by nursing staff in acute orthopaedic wards in Taiwan.

    PubMed

    Lin, Pi-Chu; Wang, Ching-Hui; Liu, Yo-Yi; Chen, Chyang-Shiong

    2013-12-01

    The purpose of this study was to understand the postoperative rehabilitation patterns of orthopaedic patients and to explore factors which affected the patients' functional recovery. A descriptive study with convenience sampling was performed. Study participants included orthopaedic inpatients from two hospitals in Taipei. In total, 100 patients were selected with an average age of 60.88 ± 17.61 years, of which the most common type of surgery was a total knee replacement (49.0%). Among these participants, 79.0% received rehabilitation guided by nursing staff, while only 6.0% were instructed by a physical therapist. The predictive factor for the time to first ambulation was the intensity of pain experienced on the second day after the operation, which accounted for 4.5% of the total variance. As for the functional status prior to discharge, predictive factors included the time to first ambulation and whether nursing staff provided instructions on rehabilitation, which accounted for 11.2% of the total variance. We recommend that professional staff should promote patient guidance toward postoperative rehabilitation, assistance in achieving the first ambulation and a resolution of obstacles to rehabilitation.

  4. 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

  5. Older Jail Inmates and Community Acute Care Use

    PubMed Central

    Chodos, Anna H.; Ahalt, Cyrus; Cenzer, Irena Stijacic; Myers, Janet; Goldenson, Joe

    2014-01-01

    Objectives. We examined older jail inmates’ predetainment acute care use (emergency department or hospitalization in the 3 months before arrest) and their plans for using acute care after release. Methods. We performed a cross-sectional study of 247 jail inmates aged 55 years or older assessing sociodemographic characteristics, health, and geriatric conditions associated with predetainment and anticipated postrelease acute care use. Results. We found that 52% of older inmates reported predetainment acute care use and 47% planned to use the emergency department after release. In modified Poisson regression, homelessness was independently associated with predetainment use (relative risk = 1.42; 95% confidence interval = 1.10, 1.83) and having a primary care provider was inversely associated with planned use (relative risk = 0.69; 95% confidence interval = 0.53, 0.89). Conclusions. The Affordable Care Act has expanded Medicaid eligibility to all persons leaving jail in an effort to decrease postrelease acute care use in this high-risk population. Jail-to-community transitional care models that address the health, geriatric, and social factors prevalent in older adults leaving jail, and that focus on linkages to housing and primary care, are needed to enhance the impact of the act on acute care use for this population. PMID:25033146

  6. The acoustic environment of intensive care wards based on long period nocturnal measurements.

    PubMed

    Xie, Hui; Kang, Jian

    2012-01-01

    The patients in the Intensive Care Units are often exposed to excessive levels of noise and activities. They can suffer from sleep disturbance, especially at night, but they are often too ill to cope with the poor environment. This article investigates the acoustic environment of typical intensive care wards in the UK, based on long period nocturnal measurements, and examines the differences between singlebed and multibed wards, using statistical analysis. It has been shown that the acoustic environment differs significantly every night. There are also significant differences between the noise levels in the singlebed and multibed wards, where acoustic ceilings are present. Despite the similar background noises in both ward types, more intrusive noises tend to originate from the multibed wards, while more extreme sounds are likely to occur in the single wards. The sound levels in the measured wards for each night are in excess of the World Health Organization's (WHO) guide levels by at least 20 dBA, dominantly at the middle frequencies. Although the sound level at night varies less than that in the daytime, the nocturnal acoustic environment is not dependant on any specific time, thus neither the noisiest nor quietest period can be determined. It is expected that the statistical analysis of the collected data will provide essential information for the development of relevant guidelines and noise reduction strategies.

  7. Students' Perceptions on an Interprofessional Ward Round Training – A Qualitative Pilot Study

    PubMed Central

    Nikendei, C.; Huhn, D.; Pittius, G.; Trost, Y.; Bugaj, T. J.; Koechel, A.; Schultz, J.-H.

    2016-01-01

    Introduction: Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students’, nurses’ as well as physiotherapists’ views on a simulation-based interprofessional ward round training. Methods: In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second) volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups. Results: Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups. Conclusion: The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice. PMID:27280125

  8. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 ...

  9. Validation of screening tools to assess appetite among geriatric patients.

    PubMed

    Hanisah, R; Suzana, S; Lee, F S

    2012-07-01

    Poor appetite is one of the main contributing factors of poor nutritional status among elderly individuals. Recognizing the importance of assessment of appetite, a cross sectional study was conducted to determine the validity of appetite screening tools namely, the Council on Nutrition Appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) against the appetite, hunger and sensory perception questionnaire (AHSPQ), measures of nutritional status and food intake among geriatric patients at the main general hospital in Malaysia. Nutritional status was assessed using the subjective global assessment (SGA) while food intake was measured using the dietary history questionnaire (DHQ). Anthropometric parameters included weight, height, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A total of 145 subjects aged 60 to 86 years (68.3 ± 5.8 years) with 31.7% men and 68.3% women were recruited from outpatients (35 subjects) and inpatients (110 subjects) of Kuala Lumpur Hospital of Malaysia. As assessed by SGA, most subjects were classified as mild to moderately malnourished (50.4%), followed by normal (38.6%) and severely malnourished (11.0%). A total of 79.3% and 57.2% subjects were classified as having poor appetite according to CNAQ and SNAQ, respectively. CNAQ (80.9%) had a higher sensitivity than SNAQ (69.7%) when validated against nutritional status as assessed using SGA. However, the specificity of SNAQ (62.5%) was higher than CNAQ (23.2%). Positive predictive value for CNAQ and SNAQ were 62.6% and 74.7%, respectively. Cronbach's alpha for CNAQ and SNAQ were 0.546 and 0.578, respectively. History of weight loss over the past one year (Adjusted odds ratio 2.49) (p < 0.01) and thiamine intake less than the recommended nutrient intake (RNI) (Adjusted odds ratio 3.04) (p < 0.05) were risk factors for poor appetite among subjects. In conclusion, malnutrition and poor appetite were prevalent among the

  10. Developing Leadership in Geriatric Education. Proceedings of the Annual Summer Geriatric Institute (5th, Lexington, Kentucky, July 23-25, 1990).

    ERIC Educational Resources Information Center

    Gardner, Davis L., Ed.; Patzwald, Gari-Anne, Ed.

    Papers in these proceedings are organized into four sections: (1) Research Studies in Aging; (2) Innovative Approaches in Geriatric Education; (3) Faculty Development Models; and (4) "The Publication Process: Perils and Pearls" (Workshop). Clinical Experiences: Design Not Chance" (Matzo); "The Development of a Collaborative Gerontological Research…

  11. Do post-take ward round proformas improve communication and influence quality of patient care?

    PubMed Central

    Thompson, A; Jacob, K; Fulton, J; McGavin, C

    2004-01-01

    The post-take ward round is a critical time for reviewing the initial history, examination and results, and the stage at which further treatment and investigations will be determined. However documentation of this ward round is often inadequate, so the benefits of decision making are lost. The documentation of 95 ward rounds was assessed for key items of information before and after the introduction of a proforma sheet. The introduction of the proforma led to a significant improvement in the documentation of a diagnosis, management plan, prophylaxis for deep vein thrombosis, and resuscitation status (p<0.05), which will have a significant impact on patient care. PMID:15537856

  12. Food work and feeding assistance on hospital wards.

    PubMed

    Heaven, Ben; Bamford, Claire; May, Carl; Moynihan, Paula

    2013-05-01

    Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals. PMID:23009613

  13. Profiling psychotropic discharge medication from a children's psychiatric ward.

    PubMed

    Akram, Gazala

    2015-10-01

    Background Community prescribing of medication to treat psychiatric illness in children is increasing. However, details about medication prescribed at discharge from psychiatric inpatient services for children are scarce. Objectives Characterise the nature of psychotropic medication prescribed on discharge from a children's psychiatric ward over a 15-year period. Method Retrospective analysis of discharge summary letters of all discharges occurring between Jan 1997 to Dec 2012. Results 234 children (152 males and 82 females) were discharged with 117 (50%) prescribed psychotropic medication at discharge. 133 medicines were prescribed (stimulants n = 49, antipsychotics n = 31, antidepressants n = 22, mood stabilisers n = 1, other ADHD medication n = 11, melatonin n = 10, benzodiazepines n = 7, other n = 2). Risperidone was the most popular antipsychotic at a mean daily dose of 1 mg (range 0.25-4 mg). Fifty per cent were given an unlicensed medicine or a licensed drug was used in an unlicensed manner, of which risperidone was the most common (n = 14). Sleep disturbance and tics were most often treated using unlicensed/off label medication (n = 10). Conclusion Psychotropic medication is routinely used in inpatient children's services, with the majority of use confined to stimulants and atypical antipsychotics. Much of the antipsychotic use is for unlicensed indications or at unlicensed doses. PMID:25893488

  14. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    PubMed

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice.

  15. Food work and feeding assistance on hospital wards.

    PubMed

    Heaven, Ben; Bamford, Claire; May, Carl; Moynihan, Paula

    2013-05-01

    Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals.

  16. Provocative dietary factors in geriatric hypertension: A surveillance study.

    PubMed

    Jagtap, Madhavi V; Deole, Yogesh S; Chandola, Harimohan; Ravishankar, B

    2012-10-01

    Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide being more prevalent in old age. The present survey of hypertensive patients fulfilling the standard diagnostic criteria of WHO/ISH (2004) is carried out in geriatric age group from the Saurashtra region of Gujarat in India to observe the dietary pattern and provocative factors. Total 120 patients of 50 to 80 years of age having systolic blood pressure >140 mm Hg and ≤180 mm Hg and diastolic blood pressure >90 mm Hg and ≤110 mm Hg irrespective of gender and religion were selected for the present study. They were interviewed for list of provocative factors enlisted in Ayurveda. As observed, the study supported the facts described in Ayurveda that dietary etiological factors, such as excess intake of Lavana (salty), Amla (sour), Katu (pungent), Tikshna, Ushna (hot), Vidahi (producing burning sensation), Viruddha (incompatible), Snigdha (unctuous), Abhishyandi (leading to obstruction), Madhura (sweet), Guru (heavy to digest) dietary articles, Ajirnashana (taking diet before complete digestion of previous meal), Adhyashana (repeated eating at short intervals), will vitiate Rakta dhatu as well as Pitta dosha in the body leading to disorders like hypertension. Hypertension in old age is found to be a disease of Vata-Pitta dominant vitiation with the involvement of Rasa, Rakta, Meda as main Dushya (vitiated factors) and dietary factors can contribute to worsening of the disease. The etiological factors having role in the pathogenesis can also be applied for preventive guidelines for the management of hypertension. PMID:23723671

  17. 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

  18. Content validity of the Geriatric Health Assessment Instrument

    PubMed Central

    Pedreira, Rhaine Borges Santos; Rocha, Saulo Vasconcelos; dos Santos, Clarice Alves; Vasconcelos, Lélia Renata Carneiro; Reis, Martha Cerqueira

    2016-01-01

    ABSTRACT Objective Assess the content validity of the Elderly Health Assessment Tool with low education. Methods The data collection instrument/questionnaire was prepared and submitted to an expert panel comprising four healthcare professionals experienced in research on epidemiology of aging. The experts were allowed to suggest item inclusion/exclusion and were asked to rate the ability of individual items in questionnaire blocks to encompass target dimensions as “not valid”, “somewhat valid” or “valid”, using an interval scale. Percent agreement and the Content Validity Index were used as measurements of inter-rater agreement; the minimum acceptable inter-rater agreement was set at 80%. Results The mean instrument percent agreement rate was 86%, ranging from 63 to 99%, and from 50 to 100% between and within blocks respectively. The Mean Content Validity Index score was 93.47%, ranging from 50 to 100% between individual items. Conclusion The instrument showed acceptable psychometric properties for application in geriatric populations with low levels of education. It enabled identifying diseases and assisted in choice of strategies related to health of the elderly. PMID:27462889

  19. A current perspective on geriatric lower urinary tract dysfunction

    PubMed Central

    Jung, Ha Bum; Kim, Hyung Jee

    2015-01-01

    Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction. PMID:25874039

  20. The prevalence and type of glaucoma in geriatric patients.

    PubMed

    Peräsalo, R; Raitta, C

    1992-06-01

    A group of 100 institutionalized geriatric patients aged 69-94 years (mean 81.2 years) was studied at Koskela Helsinki Municipal Hospital. The selection of the patients was randomized by taking 100 patients having a birth-date divisible by five. Glaucoma occurred in 15% of the patients (14 women and one man). Six patients had bilateral primary open-angle glaucoma. One patient had capsular glaucoma in one eye and secondary glaucoma in the other eye. Eight patients had glaucoma only in one eye; three narrow-angle glaucoma, three primary open-angle glaucoma and two secondary glaucoma. Exfoliation occurred in 21 patients (26%, 21/80). Ten patients had bilateral exfoliation and 11 exfoliation only in one eye. IOP was measured in 75 patients, 150 eyes, with applanation tonometry, averaging 12.5 mmHg (SD 5.0), and in 22 patients, 44 eyes, with Schiötz tonometry, averaging 16.3 mmHg (SD 5.6). Visual acuity for long distance and also the reading acuity were greater than 0.3 in 66% (54/82).

  1. The association of serotonin transporter gene polymorphism and geriatric depression: a meta-analysis.

    PubMed

    Gao, Ze; Yuan, Hanyu; Sun, Minghan; Wang, Zhen; He, Yiqin; Liu, Dexiang

    2014-08-22

    Serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism is the genetic variant coding for the serotonin transporter and may play an important role in the etiology of depression. However, genetic studies examining the relationship between 5-HTTLPR polymorphism and geriatric depression have produced inconsistent results. We conducted a meta-analysis to compare the frequency of 5-HTTLPR variants in geriatric depression cases and non-depressed controls in the elderly. A total of 5 studies involving 579 geriatric cases and 1372 non-depressed controls met the inclusion criteria. With strong statistical power, pooled odds ratios (ORs) and 95% confidence intervals (CIs) for genotypic analyses (S carrier versus L/L, S/S versus L/L) were provided. The results of our analysis indicate statistically significant association between S allele and the risk of geriatric depression (OR ScarriervsS/S=1.29, 95% CI 1.01-1.66; OR S/SvsL/L=1.68, 95% CI 1.20-2.35). Our findings suggest that 5-HTTLPR polymorphism is of importance in the development of geriatric depression.

  2. Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients.

    PubMed

    Fligor, Scott C; Hamill, Mark E; Love, Katie M; Collier, Bryan R; Lollar, Dan; Bradburn, Eric H

    2016-07-01

    Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population. PMID:27457863

  3. 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.

  4. Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients.

    PubMed

    Fligor, Scott C; Hamill, Mark E; Love, Katie M; Collier, Bryan R; Lollar, Dan; Bradburn, Eric H

    2016-07-01

    Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population.

  5. The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment.

    PubMed

    Nicholls, Daniel; Kidd, Kevin; Threader, Jennifer; Hungerford, Catherine

    2015-08-01

    This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers.

  6. View of compartment C110, senior officers ward room from port ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of compartment C-110, senior officers ward room from port to starboard, showing wooden furnishings, deck stanchions and the olympia's piano. (084) - USS Olympia, Penn's Landing, 211 South Columbus Boulevard, Philadelphia, Philadelphia County, PA

  7. [Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care].

    PubMed

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

  8. Learner-Centered Online Courses/Programs in Gerontology and Geriatrics: New Responses to Changing Needs of Health Professionals

    ERIC Educational Resources Information Center

    Cotter, J. James; Welleford, E. Ayn; Drain, Cecil B.

    2008-01-01

    This article describes recent trends that have led to an emphasis on a learner-centered approach to gerontology and geriatrics education especially in distance-based education. A learner-centered approach to education has combined with technological advances to stimulate distance-enhanced education for students in geriatric and gerontology…

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

    PubMed Central

    Cefalu, Charles A.; Schwartz, Robert S.

    2007-01-01

    Formal training in geriatric medicine in Louisiana is in its infancy. This article portrays the struggle of the sole functioning geriatric medicine training program and its trials and tribulations in a survival mode, opportunities that come with disaster as well as lessons learned post-Katrina. PMID:17534025

  10. 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…

  11. Changes in geriatric rehabilitation: a national programme to improve quality of care. The Synergy and Innovation in Geriatric Rehabilitation study

    PubMed Central

    Caljouw, Monique A.A.; Zekveld, Ineke G.; van Balen, Romke; de Groot, Aafke J.; van Haastregt, Jolanda C.M.; Schols, Jos M.G.A.; Hertogh, Cees M.P.M.; Gussekloo, Jacobijn; Achterberg, Wilco P.

    2015-01-01

    Objective To describe changes in the health service delivery process experienced by professionals, patients and informal caregivers during implementation of a national programme to improve quality of care of geriatric rehabilitation by improving integration of health service delivery processes. Study setting Sixteen skilled nursing facilities. Study design Prospective study, comparing three consecutive cohorts. Data collection Professionals (elderly care physicians, physiotherapists and nursing staff) rated four domains of health service delivery at admission and at discharge of 1075 patients. In addition, these patients [median age 79 (Interquartile range 71–85) years, 63% females] and their informal caregivers rated their experiences on these domains 4 weeks after discharge. Principal findings During the three consecutive cohorts, professionals reported improvement on the domain team cooperation, including assessment for intensive treatment and information transfer among professionals. Fewer improvements were reported within the domains alignment with patients’ needs, care coordination and care quality. Between the cohorts, according to patients (n = 521) and informal caregivers (n = 319) there were no changes in the four domains of health service delivery. Conclusion This national programme resulted in small improvements in team cooperation as reported by the professionals. No effects were found on patients’ and informal caregivers’ perceptions of health service delivery. PMID:27118962

  12. Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis

    PubMed Central

    Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph

    2014-01-01

    Background Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. Purpose To provide insights into students’ experiences regarding their on-ward training with and without accompanying PAL tutors. Methods A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. Results The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students’ anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. Conclusion On-ward PAL programs represent a particularly valuable tool for students’ support in training clinical competencies on ward. The tutor–student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians. PMID:25278789

  13. Ophthalmology hospital wards contamination to pathogenic free living Amoebae in Iran.

    PubMed

    Lasjerdi, Zohreh; Niyyati, Maryam; Lorenzo-Morales, Jacob; Haghighi, Ali; Taghipour, Niloofar

    2015-09-01

    The present study was conducted to determine the occurrence of potentially pathogenic free-living amoeba in ophthalmology wards in reference hospitals in Iran. Since an increasing number of Acanthamoeba Keratitis cases after eye surgery and eye trauma have been recently observed in this country, it could be possible that the disinfection procedures undertaken in the clinical setting may not have a good hygiene and disinfection procedures, hence the aim of this study. Therefore, 42 dust and biofilm samples were collected from different areas of ophthalmology wards and checked for the presence of FLA using morphological criteria, PCR based analysis and DNA sequencing. Of the 42 samples from dust and biofilm sources, 18(42.86%) isolates were found to contain FLA and 12(92.3%) isolates belonged to Acanthamoeba T4 genotype. Isolation of the pathogenic genotype T4 from medical instruments, including slit lamp in corneal wards, may be a threat for patients undergoing eye surgery in these wards. Other FLA isolated in this study included Acanthamoeba genotype T5, Vahlkampfia sp, Naegleria australiensis, Vermamoeba vermiformis and Echinamoeba exudans. To our knowledge, this is the first report of the presence of potentially pathogenic FLA in ophthalmology wards in Iran. Improved disinfection methods and monitoring of hospitals ward are thus necessary in this area in order to minimize the risk of infection in patients.

  14. [Airborne Fungal Aerosol Concentration and Distribution Characteristics in Air- Conditioned Wards].

    PubMed

    Zhang, Hua-ling; Feng, He-hua; Fang, Zi-liang; Wang, Ben-dong; Li, Dan

    2015-04-01

    The effects of airborne fungus on human health in the hospital environment are related to not only their genera and concentrations, but also their particle sizes and distribution characteristics. Moreover, the mechanisms of aerosols with different particle sizes on human health are different. Fungal samples were obtained in medicine wards of Chongqing using a six-stage sampler. The airborne fungal concentrations, genera and size distributions of all the sampling wards were investigated and identified in detail. Results showed that airborne fungal concentrations were not correlated to the diseases or personnel density, but were related to seasons, temperature, and relative humidity. The size distribution rule had roughly the same for testing wards in winter and summer. The size distributions were not related with diseases and seasons, the percentage of airborne fungal concentrations increased gradually from stage I to stage III, and then decreased dramatically from stage V to stage VI, in general, the size of airborne fungi was a normal distribution. There was no markedly difference for median diameter of airborne fungi which was less 3.19 μm in these wards. There were similar dominant genera in all wards. They were Aspergillus spp, Penicillium spp and Alternaria spp. Therefore, attention should be paid to improve the filtration efficiency of particle size of 1.1-4.7 μm for air conditioning system of wards. It also should be targeted to choose appropriate antibacterial methods and equipment for daily hygiene and air conditioning system operation management.

  15. [Pharmacological treatment of dementia: when, how and for how long. Recommendations of the Working Group on Dementia of the Catalan Society of Geriatrics and Gerontology].

    PubMed

    Rodríguez, Daniel; Formiga, Francesc; Fort, Isabel; Robles, María José; Barranco, Elena; Cubí, Dolors

    2012-01-01

    Dementia in general--and Alzheimer's disease (AD) in particular--are bound to loom large among the most acute healthcare, social, and public health problems of the 21st century. AD shows a degenerative progression that can be slowed down--yet not halted--by today's most widely accepted specific treatments (those based on cholinesterase inhibitors as well as those using memantine). There is enough evidence to consider these treatments advisable for the mild, moderate and severe phases of the illness. However, in the final stage of the disease, a decision has to be made on whether to withdraw such treatment or not. In this paper, the Working Group on Dementia for the Catalan Society of Geriatrics and Gerontology reviews the use of these specific pharmacological treatments for AD, and, drawing on the scientific evidence thus gathered, makes a series of recommendations on when, how, and for how long, the currently existing specific pharmacological treatments should be used. PMID:22633250

  16. [Pharmacological treatment of dementia: when, how and for how long. Recommendations of the Working Group on Dementia of the Catalan Society of Geriatrics and Gerontology].

    PubMed

    Rodríguez, Daniel; Formiga, Francesc; Fort, Isabel; Robles, María José; Barranco, Elena; Cubí, Dolors

    2012-01-01

    Dementia in general--and Alzheimer's disease (AD) in particular--are bound to loom large among the most acute healthcare, social, and public health problems of the 21st century. AD shows a degenerative progression that can be slowed down--yet not halted--by today's most widely accepted specific treatments (those based on cholinesterase inhibitors as well as those using memantine). There is enough evidence to consider these treatments advisable for the mild, moderate and severe phases of the illness. However, in the final stage of the disease, a decision has to be made on whether to withdraw such treatment or not. In this paper, the Working Group on Dementia for the Catalan Society of Geriatrics and Gerontology reviews the use of these specific pharmacological treatments for AD, and, drawing on the scientific evidence thus gathered, makes a series of recommendations on when, how, and for how long, the currently existing specific pharmacological treatments should be used.

  17. Staying in the game: the 10-step approach to sustaining geriatrics education in hospitalists and subspecialty providers.

    PubMed

    Gillespie, Suzanne M; Brandt, Lynsey E; Chang, Anna; Chao, Serena H; Corcoran, Amy M; Miller, Rachel; Harper, G Michael; Levine, Sharon A; Medina-Walpole, Annette

    2014-08-01

    Geriatrics as a field has been fortunate to have the support of several philanthropic organizations to advance geriatrics education and training in the past two decades. Awardees of such grants were presented with unparalleled opportunities to develop new and innovative educational initiatives affecting learners at multiple levels and in multiple disciplines and specialties. The lessons learned from the Donald W. Reynolds Foundation initiatives about effect and sustainability are invaluable to the ongoing strategic development of geriatrics nationally. This article highlights successful educational initiatives developed at four institutions with past and current Donald W. Reynolds Foundation funding. Following an ice hockey playbook, this article identifies 10 strategies and initiatives to "stay in the geriatrics game" by training hospitalists and subspecialty providers. The authors' collective experience suggests that geriatrics educational initiatives can not only influence provider education, but also improve the care of older adults in multiple settings.

  18. [The emergent role of sarcopenia: Preliminary Report of the Observatory of Sarcopenia of the Spanish Society of Geriatrics and Gerontology].

    PubMed

    Cruz-Jentoft, Alfonso J; Triana, Federico Cuesta; Gómez-Cabrera, Mari Carmen; López-Soto, Alfonso; Masanés, Ferran; Martín, Pilar Matía; Rexach, José Antonio Serra; Hidalgo, Domingo Ruiz; Salvà, Antoni; Viña, José; Formiga, Francesc

    2011-01-01

    Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.

  19. 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

  20. 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