The Portal of Geriatrics Online Education

Pharmacology/Toxicology

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 31--The Bionic Bleeding Man

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

The Step1 Test Prep Series was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Educational objectives: 

The second-year medical student studying for the Step2CK exam should be able to:

  • Identify the drug-drug interaction of trimethoprim-sulfamethoxazole and warfarin
  • Explain warfarin's mechanism of action
  • Explain the role of Vitamin K in Warfarin overdose
  • Explain aspirin's mechanism of action
  • Identify normal INR values for a patient on anti-coagulant therapy
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 31--The Bionic Bleeding Man. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 27--Mr. Shahani's Gotta Go

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

The Step1 Test Prep Series was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Educational objectives: 

The second-year medical student studying for the Step2CK exam should be able to:

  • Recognize the symptoms and treatment of benign prostatic hyperplasia (BPH).
  • Recognize the etiology and pathogenesis of BPH in geriatric patients.
  • Describe the mechanism of action of Finasteride.
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 27--Mr. Shahani's Gotta Go. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 113--Oh Dang! Pulmonary Edema

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

The Step 1 Test Prep Serices was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step 1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri...

Educational objectives: 

The second-year medical student studying for the Step 1 exam should be able to:

  • Know the physilogic actions of furosemide on the nephron and medullary intersitium of the kidney.
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 113--Oh Dang! Pulmonary Edema. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Geropsychiatric Nursing Competency Enhancements

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

Nurses care for older adults in health and illness across the full range of health care settings. Especially in late life, physical illness often precipitates and/or is accompanied by psychiatric symptoms. Therefore it is important that nursing education programs provide knowledge and skills that prepare nurses to care for older adults with mental health concerns and psychiatric/substance misuse disorders.

The Geropsychiatric Nursing Collaborative has developed the following resources to draw attention to the special needs of older adults.

  • Definition of Geropsychiatric Nursing. This definition serves to guide future discussions about preparing nurses to care for older adults with mental health concerns.
  • Key Concepts. These key concepts are foundational to the geropsychiatric nursing competency enhancements.
  • Geropsychiatric Nursing Competency Enhancements. These enhancements are not intended to ‘stand-alone,’ but rather to enhance existing or to-be-developed competencies by relevant professional nursing organizations. The competency enhancements are organized in four topic areas: entry level and advanced practice level for Gerontological, Psychiatric-Mental Health and Other Specialties Caring for Older Adults, i.e.  Adult, Family, Acute Care, and Women’s Health. The advanced level category is further categorized by role, either Nurse Practitioner or Clinical Nurse Specialist.
Educational objectives: 

Based on the competency enhancements, the Geropsychiatric Nursing Collaborative is identifying and evaluating the quality and suitability (appropriateness, evidence base, relevance, cultural sensitivity, and currency) of extant curricular and training materials for each level of curricula and identifying gaps at both the entry level, i.e., Associate and Bachelor of Science in Nursing, and the advanced level, i.e.,Master of Science in Nursing in Gerontological, Psychiatric-Mental Health and Adult/Family/Acute Care Women’s Health  Clinical Nurse Specialist and Nurse Practitioner Programs and the Doctor of Nursing Practice. The project will foster linkages of nursing education programs whose graduates will care for older adults to basic, graduate, post-graduate and continuing education geropsychiatric curricular offerings (courses, textbooks, journal articles, toolkits, training films, web-based courses and materials, course syllabi, and learning tools). All levels of nurses practicing in many different settings will require ‘retooling’ with current knowledge and skills in order to best provide mental health services to older adults.

Additional information/Special implementation requirements or guidelines: 

The competency enhancements are meant to inform the development of new and the updating of existing nursing competencies for the level and specialty indicated.

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

Buckwalter, K., Beck, C, Evans, L. (In press). Envisioning the Future of Geropsychiatric Nursing. In K.D. Melillo & S. C. Houde (Eds.). Geropsychiatric and Mental Health Nursing, 2nd Ed. Boston: Jones & Bartlett Publishers.

Date posted: 
Wed, 04/04/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/04/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . Geropsychiatric Nursing Competency Enhancements. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/223

UM Geriatrics Clinical Decision Making Instrument

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

The University of Michigan Geriatrics Center, with support from the Donald W. Reynolds Foundation, developed this 24-item multiple choice instrument for assessing knowledge of clinical geriatrics among health professionals. The instrument emphasizes inpatient care and common geriatric syndromes. It was designed primarily for use among house officers (resident and fellows) in surgical specialties and medical subspecialties, but may also be used among residents in primary care disciplines and medical students. The UM Geriatrics Clinical Decision Making Assessment should prove useful to training programs in surgical specialties and medical subspecialties to gather baseline data, implement curricula, and measure the effects of curricular change on the knowledge of trainees in caring for the complex and interacting needs of older adults. The instrument is also available at http://www.med.umich.edu/geriatrics/edu/gme1.htm

This product consists of the following documents:

  • UM Geriatrics Clinical Decision-Making Assessment
  • Answer Key with Explanations
Educational objectives: 

This instrument was developed to provide program directors a general indicator of geriatrics clinical knowledge among groups of house officers, rather than a comprehensive assessment of individual physicians’ knowledge related to the care of older patients. The instrument was designed to be brief to enhance administration to large groups of house officers with busy schedules.

Specifically, the instrument was designed to include:

  • (a) a focus on clinical management rather than nonclinical issues (e.g., social support, long-term care, health systems organization, and finance; to maintain coherence, relevance, and brevity);
  • (b) a case-based multiple choice format (to enhance clinical relevance and reliability of scoring); and
  • (c) a length of 20 to 25 items (to allow a completion time of 30 minutes or less).
Additional information/Special implementation requirements or guidelines: 

For reliability and validity information, read the article cited below, “Brief Instrument to Assess Geriatrics Knowledge of Surgical and Medical Subspecialty House Officers” (published in the Journal of General Internal Medicine).

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

Williams, B. C., & Fitzgerald, J. T. (2006). Brief report: Brief instrument to assess geriatrics knowledge of surgical and medical subspecialty house officers. Journal of General Internal Medicine, 21(5), 490-493. http://dx.doi.org/10.1111/j.1525-1497.2006.00433.x

Date posted: 
Thu, 04/29/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/29/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . UM Geriatrics Clinical Decision Making Instrument. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Quick Reference for Geriatric Syndromes

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

A quick reference card set of geriatric syndromes designed for bedside use, which fits in a white coat pocket.

Educational objectives: 

Identification of, assessment of, and intervention with important geriatric syndromes frequently encountered in inpatient and outpatient clinical settings.

Additional information/Special implementation requirements or guidelines: 

Content available as PDF file. Cards may be printed and bound for hard-copy reference.

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

2008 Southern Group on Educational Affairs (SGEA) Conference (demonstration)

Date posted: 
Wed, 03/31/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 07/18/2012
Contact Person/Corresponding Author:



Suggested Citation:
Quick Reference for Geriatric Syndromes. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Texas Tech Medcast Reynolds Geriatric Step 2 CK Test Prep Series 09-10: No. 42--Harry the Hyperkalemic

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

The Step2CK Test Prep Series was created by fourth-year students at the Texas Tech School of Medicine in Lubbock as a project of the fourth-year geriatrics rotation. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. 

Educational objectives: 

This espisode is based on Question 42 of the 2009 Step2CK Sample Exam.

Learning Objectives: the third-year medical student studying for the Step2CK exam should be able to:

  • List the common diuretic medication that can cause hyperkalemia 
  • Identify the importance of adverse drug effects on the geriatric population 
  • Describe the risk of polypharmacy in elderly adults
Additional information/Special implementation requirements or guidelines: 

The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2009 Step2CK Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri.... For more information on the series, go to http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Date posted: 
Fri, 08/12/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , and . Texas Tech Medcast Reynolds Geriatric Step 2 CK Test Prep Series 09-10: No. 42--Harry the Hyperkalemic. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/223

Pills, Pills and More Pills: A Pill Box Exercise to Reduce Polypharmacy

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

An interactive, “hands-on” polypharmacy experience paired with group reflection, improves learner knowledge of medication adherence barriers and solutions, resulting in decreased number and dosing frequency of medications of their elderly patients.

At the first session, each learner starts by filling out a 5 question pre-survey. Each learner is then given a pill box to fill with "medications" (various candies) according to the medication list of an actual geriatric patient. The learners fill the boxes, and a faculty member facilitates a discussion about challenges to filling the box (e.g., dementia, arthritis, visual loss, neuropathy). Learners are instructed to take the "medications", as prescribed, for one week.

At the second session, one week later, learners report back to the group and describe their experience. The faculty then facilitate a discussion about barriers and solutions (both physician and patient/family initiated) that could be used to aid adherence. Ideas that may be emphasized include: non-judgemental inquiry regarding adherence, understanding patient goals, collaboration with the patient in regards to medications prescribed and decreasing number and frequency of medication dosing. Learners end the exercise by taking a 5 question post-survey.

The exercise has been used with a variety of learner levels, M1 (N=30), M3,M4 (N=25), PGY 1-4 (N=23). This exercise has generally been used in small groups of 6 learners during their geriatrics rotation, but was also used in our Senior Mentor Program with a group size of 30.

Initial data (N=78) showed an increased understanding of adherence barriers (3.5 to 4.9) and solutions (3.0 to 4.8), as well as increased patient medication education (2.6 to 4.0) and increased medication discontinuance/dosing changes (3.0 to 4.3) on a scale of 1-6 with 6 as highest. Results varied by learner level with most medication dose changes at the resident level.

Educational objectives: 
  1. List 5 barriers to medication adherence in elderly patients.
  2. List 3 solutions to medication non-adherence that physicians/providers could initiate.
  3. List 3 solutions to medication non-adherence that patients/families could implement.
  4. Increased learner behavior of educating patients in regards to medications.
  5. Increased learner behavior of discontinuing medications/decreasing medication frequency of patients.
Additional information/Special implementation requirements or guidelines: 

Materials needed:

  1. 1 pill box per learner (each pill box with small boxes for Sun-Sat., with 4 boxes/day for total of 28 small boxes per pill box.)
  2. Various small candies (M&Ms, Skittles, Wasabi peas, breath mints, other) sorted by type/color
  3. Pill bottles (15 bottles/set, 2-3 learners can use 1 set) filled with candies above
  4. Labels for each bottle with medication name and dosing schedule (e.g: lisinopril 5 mg po daily) (15 labels are needed for each medication set) 5. Large, gallon-size zip-lock bags (1 per each medications set of 15 bottles)
  5. Patient's medication list (1 list per every 2-3 learners)
  6. Pre-survey (1 per learner)
  7. Post-survey (1 per learner)


Flow of session: Session 1:

  1. Divide learners in groups of 2-3 learners
  2. Hand out pre-survey and empty pill box to each learner
  3. Hand out zip-lock bag containing: 15 labeled pill bottles (filled with candies) and patient medication list to each group
  4. Instruct learners to complete pre-survey and orient them to activity objectives and session flow
  5. Instruct learners to fill their pill box with "medications" according to the patient medication list provided.
  6. Facilitate discussion of potential difficulties in filling the pill boxes
  7. Instruct learners to take "medications" as prescribed for one week.
  8. Collect zip-lock bags with pill bottles and medication lists


Session 2: (1 week later) Facilitate discussion asking:

  1. "How did it go?"
  2. Ask learners to identify barriers to adherence they encountered
  3. Ask learners to identify potential solutions to non-adherence by patients
  4. Ask learners to identify potential solutions to non-adherence by providers
  5. Summarize experience
  6. Learners fill out post-survey
  7. Collect pill boxes to wash and use with other learners
Publications from, presentations from, and/or citations to this product: 
  1. AGS 2009 poster presentation: Pills, Pills and More Pills: Teaching about Barriers & Solutions in Polypharmacy
  2. Reynold's Foundation Awardees 2009 Meeting educational product demonstration
Date posted: 
Tue, 01/19/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 11/23/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . Pills, Pills and More Pills: A Pill Box Exercise to Reduce Polypharmacy. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

GeriPod: Depression in Older Adults Part 1: Risks and Diagnoses

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

This Geripod discusses Depression in Older Adults and is part 1 of a 2-part discussion by Stephen M. Scheinthal, DO, FACN, Chief of Geriatric Behavioral Health, Associate Director of NJISA, UMDNJ-SOM and Pamela Basehore, MPH, Associate Director of Education, NJISA, UMDNJ-SOM. 

Educational objectives: 

<ul>
<li>
The major risks associated with untreated depression in the elderly</li>
<li>
Common signs and symptoms and co-morbidities associated with depression in the older patient</li>
<li>
How to recognize atypical presentation of depression in the elderly</li>
<li>
Effective screening tools used to detect geriatric depression</li>
</ul>

Additional information/Special implementation requirements or guidelines: 

The New Jersey Geriatric Education Center through the New Jersey Institute for Successful Aging (NJISA), University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine presents the second audio recording of a six-part mental health educational program. For more information on the GeriPod series, please visit the UMDNJ website at http://njisa.umdnj.edu/education/geripods/index2.html.

Date posted: 
Wed, 01/27/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 01/27/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . GeriPod: Depression in Older Adults Part 1: Risks and Diagnoses. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/223

Competency-Based Test of Inpatient Geriatric Management Skills

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

Competency-based test of inpatient geriatric management skills grading admission orders for a standardized case.

Assessment of a student or resident's clinical skills in the care of the hospitalized elderly patient requires evaluation of applied knowledge measured in discrete competencies. This assessment grades the student on admission orders based on history, physical, and laboratory assessment of a standardized patient. It is designed to evaluate actual clinical behavior in the inpatient setting. The test assesses selected competencies from the Minimum Geriatric Competencies for Internal Medicine and Family Medicine Residents. Management of geriatric syndromes in the hospital setting occurs in the milieu of inter-current medical illness, co-morbid conditions, and need to prevent iatrogenic complications. As such, this assessment also incorporates competencies of hospital medicine from The Core Competencies in Hospital Medicine. 

Educational objectives: 

The patient is an elderly woman with multiple predisposing factors for falls that began to have increased falls and functional limitation after toe amputation and new initiation of amitriptyline. These elements contributed to gait impairment and increase in falls over the prior month. The acute trigger for this hospitalization was increased weakness induced by systemic infection (MRSA abscess/cellulitis) beginning approximately 3 days prior to admission. This infection triggered decreased p.o. intake, dehydration, and acute on chronic renal failure. Impaired clearance of digoxin from worsening renal function led to accumulation and digoxin toxicity manifesting as nausea and visual changes. The final event which caused her to seek medical attention was a fall with inability to get back up. As with many admissions the problem is multifactoral with both chronic and acute elements.

The test taker is expected to recognize that this patient is ill, merits empiric antibiotics with coverage against MRSA (given the high and rising prevalence of caMRSA and patients history of recent hospital exposure) with renal adjustment, and requires discontinuation of medications which are causing side effects. House officers need to anticipate and mitigate hazards of hospitalization such as delirium, falls, iatrogenic urinary tract infections, hyper/hypoglycemia, venous thromboembolism and deconditioning.

Additional information/Special implementation requirements or guidelines: 

Paper based exam in which the learner is graded based on their written admission orders for a standardized patient case.

The standardized case was developed to have face validity and piloted on a cohort of 10 third year medical students, 10 interns, and 8 third year residents who had completed an inpatient geriatric rotation. To evaluate external validity, the standardized case was then reviewed by 20 expert educators in geriatrics and hospital medicine at 6 academic medical centers nationally (eight geriatricians, eight hospitalists, and four geriatric-hospitalists). The scoring system was developed using a relative weight for each competency using average judgment of the 20 experts and multiplying the importance of the competency by the importance of acting on this competency for the patient in the standardized case.

Test performance in the pilot cohort was:

  • Third year medical student average score 49.4 (range 11-80)
  • First year resident average score 61.7% (range 36-91)
  • Third year resident average score 85.5% (range 78-100%)
Date posted: 
Wed, 12/09/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 07/11/2012
Contact Person/Corresponding Author:



Suggested Citation:
and . Competency-Based Test of Inpatient Geriatric Management Skills. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/223

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