The Portal of Geriatrics Online Education

Emergency Medicine

Malnutrition in Older Adults

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

This web-based learning module was developed for third-year medical students in the geriatric clerkship rotation. A detailed overview of the types of malnutrition, associated morbidity and mortality, risk factors, diagnosis and management across the continuum of the geriatric age span and place of service (community, hospital, long-term care) are presented. Typical macronutrient and fluid requirements, and three nutritional screening tools are cited. Social, emotional, functional, physical/medical conditions and the negative impact of numerous medications, on nutritional health and weight loss are reviewed. Clinical and biochemical markers of malnutrition are detailed in outline presentation. Non-pharmacologic interventions are discussed; potentially orexigenic agents are presented with associated cautions. Three cases are included at the end of the module; discussion of these and other cases follow in the scheduled small group facilitated discussion. 

Educational objectives: 
  • Discuss age-related physiologic changes and psychosocial risks that can predispose to poor nutritional health
  • Relate potential complications associated with anorexia, involuntary weight loss (IWL), and protein energy malnutrition for older adults who are: community dwelling, hospitalized, and are residents in long-term care
  • Briefly explain these conditions: starvation, marasmus, cachexia, kwashiorkor
  • Describe the diagnosis and management of protein energy malnutrition (PEM)
Date posted: 
Thu, 04/14/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 04/14/2011
Contact Person/Corresponding Author:



Suggested Citation:
, and . Malnutrition in Older Adults. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

Mad as a Hatter

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

Mad as a Hatter is an interactive educational game that reinforces principles of anticholinergic drug effects.  A single game set can be used with one to six learners.  Restating concepts in their own words to a teacher during and after the game allows students to assess their understanding of anticholinergic drugs and of normal cholinergic function.

Educational objectives: 

Understand pharmacology of anticholinergic drug effects

Recognize common durgs that have anticholinergic side effects

Review alterative treatments that do not cause anticholinergic effects

Recognize conditions for which all available medications have anticholinergic side effects

Additional information/Special implementation requirements or guidelines: 

Materials

The game is played with a game board and with accessory pieces that are printed and cut apart like cards.  The game board and the collection of accessory pieces are each PDF files formatted to be printed on 16 by 22 inch vinyl poster material. 

The game board is printed with

  • Two cartoon figures of patients
  • A list of 14 conditions (depression, nausea, incontinence, etc) needing treatment in these patients

Once cut apart, each accessory game piece fits onto one specific place on the board

  • Two sets each of six body organs (brain, eyes, mouth, heart, intestine, bladder), one set showing normal acetylcholine function and one set showing blocked acetylcholine function
  • 30 treatment options including drugs, non-pharmacologic treatment, or a disclaimer that no drug exists without anticholinergic effects

Methods

The game can be used with a single learner or with small groups of up to 20 learners.  If multiple game boards are available, each learner can work on an individual board.  If only one board is available, up to six learners can easily use one board.  For groups of more than six learners, the learners should be broken up into groups of two to six learners, each group working with a separate game board.

The teacher explains the two stages of the game.  In the first stage, learners place the 12 body organ pieces onto the board to review how body organ functions are affected by anticholinergic drugs.

In the second stage, learners place cards onto the board to indicate whether treatments have anticholinergic effects or not.  The teacher should state explicitly that while none of the treatements is explicitly cholinergic, several of the treatments at least do not block normal acetylcholine function.

When the game is used for a single learner,  then ask the learner after finishing the game to state concepts in their own words for the placement of each card. 

If two or more learners work on a single game board, they will usually talk out loud as they go to discuss placement of individual cards.  Nevertheless, once the game board is completed, the teacher should ask students to take turns explaining placement of one of the game cards.

An answer key can be printed on 8 ½ by 11 inch paper to hand out to learners after the game showing the correct placement of the cards.  (The game board and accessory pieces can also be printed on 8 ½ by 11 inch paper, but handling the accessory pieces is difficult when printed on paper this small.)

Publications from, presentations from, and/or citations to this product: 

This product will be presented at the 2010 Reynolds Grantee 9th Annual Meeting

Date posted: 
Fri, 10/22/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/22/2010
Contact Person/Corresponding Author:



Suggested Citation:
Mad as a Hatter. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Systems-Based Approach to Delirium for Multiple Learners-Interactive Web Module

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This product is an interactive web-based module on delirium. Delirium is presented within a systems-based practice framework. The module focuses on recognition, management and prevention of delirium. Users follow a patient from admission to discharge. It emphasizes “how-to” clinical skills including performing Mini-Cog and CAM on patients. It includes a multiple choice questionnaire and a certificate of completion for the learner’s portfolio. It may be used by a wide range of learners including medical students and residents from internal medicine, family practice, and surgical subspecialties.

Educational objectives: 
  1. Review the clinical significance of delirium
  2. Outline an evidence-based clinical approach to the confused patient in the hospital
  3. Outline an effective work-up based on known and most likely etiologies
  4. Educate learners on clinical tools such as the CAM and the Min-Cog
  5. Address delirium within a systems-based framework
  6. Provide risk assessment and illustrate how to prevent delirium
Additional information/Special implementation requirements or guidelines: 

Self-directed internet -based learning module. Module has audio so speakers or headphones are required.

Date posted: 
Wed, 01/19/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 01/19/2011
Contact Person/Corresponding Author:



Suggested Citation:
and . Systems-Based Approach to Delirium for Multiple Learners-Interactive Web Module. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

Clinical Evaluation Exercise (Mini-CEX) Mini-Cog

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This mini-CEX is designed to observe a trainee performing a Mini-Cog on a patient. The trainees are then given direct feedback on their performance.

Educational objectives: 

Learning Objectives:

  1. Demonstrate competence in introducing the subject of memory testing with a patient.
  2. Demonstrate competence in completing the mechanics of a Mini-Cog.
Date posted: 
Wed, 04/06/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/06/2011
Contact Person/Corresponding Author:



Suggested Citation:
and . Clinical Evaluation Exercise (Mini-CEX) Mini-Cog. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

Geriatric Emergency Medicine Online Curriculum (GEM-OC) 1 - Advance Directives

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This is Module One of an online five-module curriculum.  The modules, which are based on national geriatric emergency medicine competencies, cover a broad range of geriatric topics through an interactive teaching format.  They require learners to review and analyze patient information, interpersonal interactions, laboratory and imaging results, diagnoses and treatment plans. This module teaches advance directives and palliative care.

Educational objectives: 

At the end of Module One, the learner should be able to:

1) Define and differentiate among types of code status, health care proxies, and advance directives in the state where one is training.

2) Accurately identify clinical situations where life expectancy, functional status, patient preference and goals of care should override standard recommendations for screening and treatment in older adults.

3) Present palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease.

4) Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits dementia, delirium, or depression.

5) In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root cause (etiology).

Additional information/Special implementation requirements or guidelines: 

For best viewing results, please:

  • Set your monitor resolution to 1024x768
  • Launch in either Internet Explorer 6 or higher, Firefox 2 or higher or Safari 3.2.1 or higher
  • Avoid using browser navigation. Use only the navigation provided within the course.

 

Date posted: 
Tue, 10/19/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 08/08/2011
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Geriatric Emergency Medicine Online Curriculum (GEM-OC) 1 - Advance Directives. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Introduction to Geriatric Emergency Medicine

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

This lecture presentation provides an introduction to geriatric emergency medicine by discussing the special needs of the growing geriatric population and challenges faced by the emergency departments when providing care to geriatric patients. 

Educational objectives: 
  1. Improve the emergency care for older patients
  2. Educate the learners about the special needs of the geriatric population
  3. Give learners the knowledge and tools needed to feel comfortable in evaluating the older patients in the emergency room.
Date posted: 
Wed, 01/19/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 01/19/2011
Contact Person/Corresponding Author:



Suggested Citation:
Introduction to Geriatric Emergency Medicine. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

Medical Ethics

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
1
Abstract: 

This web-based module for third-year medical students reviews primary and ancillary principles of medical ethics and challenges the learner to apply these principles to patient care scenarios. Reading assignments include an ethics article (Lancet, 2009) regarding allocation of scarce medical resources. A small group discussion for this module immediately precedes an Ethical Analysis noon conference presented by a Geriatrics Fellow and is required for 3rd year medical students, but is open to anyone.

Educational objectives: 
  1. Discuss the principle of autonomy as an ethical standard, as it relates to medical decision making, and in contrast with the principle of beneficence.
  2. Define the medical ethics principle of justice.
  3. Relate examples of ambiguous distributive justice.
  4. Explain the principle of informed consent as an ethical standard, as it relates to medical decision making.
  5. Discuss the clinical situations in which life-sustaining treatment might alter one's choice of management.
  6. Describe the clinical situations in which medical futility might alter one's choice of management.
  7. Describe the important medical treatment options which must often be considered by older adults and their surrogate decision makers.
  8. Describe how one would assess a patient for decision making capacity (decisional capacity).
  9. Recommend appropriate courses of action for patients and family members as exemplified by the case studies.
Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Medical Ethics. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

SAFE-T from Babe to Sage: Injury Related Anticipatory Guidance Across the Age Continuum

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Given many common themes in pediatric, adult, and geriatric injury prevention, we designed an anticipatory guidance pocket card with the mnemonic SAFE-T, encompassing topic areas of supervision, abuse, falls, environment, and travel. Each topic area is subdivided into areas of high injury risk, and then preventative guidance is provided. 

Educational objectives: 

Use a single mnemonic device that is applicable across the continuum of life to teach injury-related anticipatory guidance.

Additional information/Special implementation requirements or guidelines: 

Purpose: Unintentional injury constitutes the fifth leading cause of mortality in the United States, and nineth among adults greater than 65years of age. In contrast to pediatric curricula, there is little formal training on injury anticipatory guidance for elderly and vulnerable patients in either inpatient or outpatient settings. Medical students and resident physicians are often not taught to discuss anticipatory issues other than smoke alarms, seatbelts, bike helmets, and preventative screening, nor are they taught to approach these in a disease specific way. While general injury prevention can be linked to developmental stage and age in pediatrics, the non-linear decline in health of an older patient makes generalized anticipatory guidance more difficult. 

Method: Given many common themes in pediatric, adult, and geriatric injury prevention, we designed an anticipatory guidance pocket card with the mnemonic SAFE-T, encompassing topic areas of supervision, abuse, falls, environment, and travel. Each topic area is subdivided into areas of high injury risk, and then preventative guidance is provided. Traditional pediatric guidance is done by developmental stage and age. The geriatric anticipatory guidance looks at trigger conditions (diseases, comorbidities, cognitive decline) and links these to the injury risk and preventative strategy.

The powerpoint is an instruction guide to the SAFE-T card.  Two versions of the SAFE-T card are included - a color version and a greyscale.

Publications from, presentations from, and/or citations to this product: 

Presented at the Presidential Poster Session, 2010 American Geriatrics Society National Meeting, Orlando, FL. Presented at the AGS Educator's Materials and Methods Swap, 2010 American Geriatrics Society National Meeting, Orlando, FL.

Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Contact Person/Corresponding Author:



Suggested Citation:
, , , and . SAFE-T from Babe to Sage: Injury Related Anticipatory Guidance Across the Age Continuum. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

"I don't want my mother to take that!" -- Addressing myths and concerns and managing side effects of opioid medications

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

This self-directed learning exercise explores common myths and misconceptions that patients, family members, and providers have regarding the use of opioids for pain. Through an unfolding case, the learner will identify ways to address these concerns and anticipate and treat common side effects of opioid medications. Multiple choice questions are included, and a brief follow up meeting with an instructor is recommended to go over the questions. A workbook is provided. Some external materials are required; see the instructions below.

Educational objectives: 

After completion of this module the student should be able to:

  1. Discuss common barriers to adequate pain management
  2. Describe common side effects of opioids and their treatment
  3. Demonstrate effective communication with patients and families to illicit and address concerns about opioids
Additional information/Special implementation requirements or guidelines: 

In order to complete this module, you will also need to access the following:

  • Article Swegle JM and Logemann C. Management of common opioid-induced adverse effects. Amer Fam Phys 2006;74(8):1347-1354
  • Fast Fact "Why Patients Do Not Take Their Opioids, 2nd ed" from EPERC
  • The answer key for this product will be provided to faculty members only. To request the answer key, send an email to Editor@POGOe.org titled "Request for Answer Key to Product #20723". Include your full name, your institution, your intended use of the product and any additional information relevant to the request. Also include your supervisor's full name, email address and phone number so that we may confirm your status as a faculty member.

This product is part of a series of 3 independent learning modules on pain for medical students.  Companion products are "Assessment and treatment of neuropathic pain" (#20725) and "Treatment of Pain in Persons with a History of Addictions" (#20723). The workbook for this series can also be accessed at http://champ.bsd.uchicago.edu/painControl/index.html

Date posted: 
Wed, 12/08/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/08/2010
Contact Person/Corresponding Author:



Suggested Citation:
"I don't want my mother to take that!" -- Addressing myths and concerns and managing side effects of opioid medications. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Geriatric Health Literacy Workshop for Medical Students and Residents

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
3
Abstract: 

This 2.5 Hour Health Literacy Workshop provides a hands-on opportunity for learners to improve communication skills and teaches problem based learning and improvement skills.  Designed for internal medicine residents and medical students, it has been piloted at the University of Chicago for all PGY-1 Internal Medicine residents rotating on the Geriatrics Rotation. This workshop is suitable to physicians-in-training at any level and across medicine subspecialties and interdisciplinary health care professions. 

During the health literacy workshop, learners view a brief lecture, role-play using “teach-back” cases, and critique patient education materials utilizing the Suitability of Assessment of Materials (SAM) (Doak and Doak) available at http://www.guidesforbeginnings.com/pdfs/SAM-for-Beginnings.pdf

Educational objectives: 

After completing this workshop, learners should be able to:

  1. Describe the anticipated demographic changes in the US over the next 50 years.
  2. Recognize the impact of low health literacy on geriatric patients.
  3. Explain the relationship between health literacy and health care disparities.
  4. Demonstrate the “teach-back” method.
  5. Edit patient handout materials for low health literacy patients.
Additional information/Special implementation requirements or guidelines: 

Course director or learners need to bring patient handout materials from their clinic or the web to analyze and revise.

The University of Arizona's Health Literacy online module (POGOe product #20029) is recommended for pre-workshop study.  The author would like to acknowledge and thank the University of Arizona for creating and publicly distributing this excellent work. 

Publications from, presentations from, and/or citations to this product: 

Farrell, T. W. (2011), Review of a Geriatric Health Literacy Workshop for Medical Students and Residents. Journal of the American Geriatrics Society, 59: 2347–2349. doi: 10.1111/j.1532-5415.2011.03720.x

Date posted: 
Fri, 04/22/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 08/17/2012
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Health Literacy Workshop for Medical Students and Residents. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

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