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Geriatrics, hospitalist medicine

Mario Barbagallo, Ligia J Dominguez, Domenico Cucinotta
Due to aging of the world population, older patients accessing health services are becoming continuously more frequent. This has increased the interest in assessing frailty and vulnerability in all specialties and general medicine. Although the term frailty has been recognized for over 30 years, there is not yet a universally recognized definition, and different care providers assess frailty and vulnerability with dissimilar tools, from very complex to very simple validated scales. Being treated with respect and dignity at the right time and place is the key message, as well as after undergoing a global evaluation both in urgency/emergency and in programmed surgery for all older surgical patients...
March 2018: Aging Clinical and Experimental Research
Veronica Sikka, S Kalra, Sagar Galwankar, Galwankar Sagar
With the increasing life expectancy, the geriatric population has been increasing over the past few decades. By the year 2050, it is projected to compose more than a fifth of the entire population, representing a 147% increase in this age group. There has been a steady increase in the number of medical and psychiatric disorders, and a large percentage of geriatric patients are now presenting to the emergency department with such disorders. The management of our progressively complex geriatric patient population will require an integrative team approach involving emergency medicine, psychiatry, and hospitalist medicine...
November 2015: Emergency Medicine Clinics of North America
Eric Swart, Eshan Vasudeva, Eric C Makhni, William Macaulay, Kevin J Bozic
BACKGROUND: Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program...
January 2016: Clinical Orthopaedics and related Research
Amanda Lathia, Michael Rothberg, Mitchell Heflin, Kelly Nottingham, Barbara Messinger-Rapport
OBJECTIVES: Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. DESIGN: MedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation...
October 1, 2015: Journal of the American Medical Directors Association
Heidi L Wald, Luci K Leykum, Melissa L P Mattison, Eduard E Vasilevskis, David O Meltzer
Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process...
May 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Evelyn M Williams, Susan Deering
Structured academic teaching on wound care was developed, based on the long-term care (LTC) setting, with the goal of ensuring that postgraduate family medicine residents attain competency in assessment and treatment of wounds and pressure ulcers (PUs). The curriculum for the 1-month learning module was based on clinical practice guidelines for the prevention, assessment, and treatment of PUs and wounds. The learning techniques used include a learners' needs assessment, a small-group didactic session, interdisciplinary bedside case discussions and a toolkit...
October 2016: International Wound Journal
Yew Yoong Ding, Yan Sun, Jam Chin Tay, Wai Fung Chong
BACKGROUND: Although acute geriatric units have improved the outcomes of hospitalized seniors, it is uncertain as to whether hospitalist care by geriatricians outside of these units confers similar benefit. OBJECTIVE: To determine whether hospitalist care by geriatricians reduces short-term mortality and readmission, and length of stay (LOS) for seniors aged 80 years and older with acute medical illnesses compared with care by other internists. DESIGN: Retrospective cohort study using administrative and chart review data on demographic, admission-related, and clinical information of hospital episodes...
October 2014: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Anna Marie Chang, Kristin L Rising
Hospital 30-day readmissions have become a major priority for hospitals. Hospitals face penalties for excessive readmissions for acute myocardial infarction (AMI) and heart failure (HF). Thus, it is important for hospitals to understand the transitions of care that occur for both of these conditions, and what tools are available to guide the processes involved. A multi-disciplinary team including Emergency Medical Service providers, Emergency Medicine providers, cardiologists, hospitalists, pharmacists, nurses, case managers, and outpatient physicians can all be involved in the process of safely transitioning a patient between care settings...
March 1, 2014: Current Emergency and Hospital Medicine Reports
Ji Won Yoo, Haesun Seol, Sun Jung Kim, Janet Miyoung Yang, Woo Sang Ryu, Too Dae Min, Jong Bum Choi, Minkyung Kwon, Sulgi Kim
AIM: To examine whether a hospitalist-directed interdisciplinary (ITD) team in an internal medicine residency program enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS: Seniors admitted to a USA teaching hospital medical floor-teaching services were allocated to the ITD (n = 379) and usual care teams (n = 383). Compared with the usual care team, the ITD team physicians carried out daily "geriatric" assessment and management, and led ITD team meetings...
January 2014: Geriatrics & Gerontology International
Robert S Young, Keiki Hinami, Adnan Arseven, Bijal Jain, Mark V Williams
INTRODUCTION: Delirium is frequently missed by inpatient health care providers despite the existence of a highly sensitive and specific assessment for delirium, the Confusion Assessment Method (CAM). The CAM, due to its test characteristics and ease of use, is an ideal physician instrument for systematic inpatient delirium screening; however, little is known about hospitalists' knowledge of the CAM. METHODS: A short survey with items assessing respondents' perceptions of delirium detection, familiarity and proficiency with the CAM, and knowledge of the CAM algorithm was administered at a regional hospital medicine conference...
October 2012: Hospital Practice (Minneapolis)
Angelena Maria Labella, Susan Eva Merel, Elizabeth Anne Phelan
Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital...
July 2011: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Danielle M Stitt, David P Elliott, Stephanie N Thompson
BACKGROUND: It has been reported that 14.1% of geriatric patients experience ≥1 medication discrepancies after hospitalization. OBJECTIVE: The goal of this study was to identify and characterize discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies. METHODS: An institutional review board-approved retrospective review was conducted of patients aged ≥65 years discharged from hospitalist and internal medicine services at a large tertiary care hospital from August 2008 to December 2009...
August 2011: American Journal of Geriatric Pharmacotherapy
Jason Hughson, Jonathan Newman, Robert C Pendleton
Hip fracture is an unfortunate and common health problem in the elderly that is associated with a 1-year mortality of 10% to 35%. Further, only 50% of these patients regain their pre-fracture level of mobility and functional status. Hospital-based clinicians are increasingly asked to comanage these patients. The purpose of this article is to summarize evidence-based clinical management practices that are relevant to hospitalist clinicians who manage hip fracture patients, and to highlight the current evidence for implementing a formal hospitalist and orthopedic comanagement care model...
February 2011: Hospital Practice (Minneapolis)
S Leung, D Logiudice, J Schwarz, C Brand
BACKGROUND: Ageism among health professionals is increasingly recognized, but few studies investigated hospital doctors' attitudes towards older people. The aims of this study were to investigate hospital doctors' attitudes towards older people and to determine whether factors, which were identified in studies on other health professionals, influence hospital doctors' attitudes. METHODS: Hospital doctors who worked in General Medicine or Aged Care units in two tertiary public hospitals in metropolitan Victoria, Australia, in 2008 were surveyed with Fraboni's Scale of Ageism (FSA), a validated instrument used to investigate attitudes towards older people...
April 2011: Internal Medicine Journal
Ethan Cumbler
Geriatricians, hospitalists, general medicine faculty, and PhD educators at the University of Chicago Pritzker School of Medicine designed the Curriculum for the Hospitalized Aging Medical Patient (CHAMP) with support from the Donald W. Reynolds Foundation. It represents a comprehensive faculty development curriculum in hospital-based geriatrics. The program comprises multiple educational modules including PowerPoint presentations, bedside teaching triggers, and workshops for faculty learners. The curriculum includes evaluation instruments, observed structured teaching exercises, and pocket teaching cards with pearls for ward-based teaching...
October 2009: Journal of the American Geriatrics Society
Param Dedhia, Steve Kravet, John Bulger, Tony Hinson, Anirudh Sridharan, Ken Kolodner, Scott Wright, Eric Howell
OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention. DESIGN: Quasi-experimental pre-post study design. SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services. INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist-physician collaborative medication reconciliation, and predischarge planning appointments...
September 2009: Journal of the American Geriatrics Society
Vincenza Snow, Dennis Beck, Tina Budnitz, Doriane C Miller, Jane Potter, Robert L Wears, Kevin B Weiss, Mark V Williams
The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4...
August 2009: Journal of General Internal Medicine
Paul R Katz, Jurgis Karuza, Orna Intrator, Vincent Mor
Marginalization of physicians in the nursing home threatens the overall care of increasingly frail nursing home residents who have medically complex illnesses. The authors propose that creating a nursing home medicine specialty, which recognizes the nursing home as a unique practice site, would go a long way toward remedying existing problems with care in skilled nursing facilities and would best serve the needs of the 1.6 million nursing home residents in the United States. Reviewing what is known about physician practice in nursing homes and hospitals, and taking a lead from the hospitalist movement, the specialty would be characterized in 3 dimensions: the degree of physicians' commitment, physicians' practice competencies, and the structure of the medical staff organization in which they practice...
March 17, 2009: Annals of Internal Medicine
Valerie J Lang, Nancy S Clark, Annette Medina-Walpole, Robert McCann
Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric patients, focusing on two common geriatric syndromes: delirium and falls. The hospitalists then ran workshops for third-year medical students during their inpatient medicine clerkship, introducing two simple tools for assessing fall risk and diagnosing delirium...
2008: Gerontology & Geriatrics Education
Paula M Podrazik, Stacie Levine, Sandy Smith, Don Scott, Catherine E Dubeau, Aliza Baron, Chad Whelan, Julie Johnson, Sandy Cook, Vineet Arora, David Meltzer, Greg Sachs
BACKGROUND: The University of Chicago Curriculum for the Hospitalized Aging Medical Patient (CHAMP) faculty development program (FDP) is targeted at hospitalists and other internists who teach residents and students in the hospital setting. The aim of CHAMP is to increase the quantity and quality of teaching of geriatric medicine pertinent to the inpatient setting. METHODS: Hospitalist and general internist faculty members who attend on the University of Chicago Medicine teaching service were invited to participate...
September 2008: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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