The development of a geriatric postgraduate education assessment instrument using a modified Delphi procedure

There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50–74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty

Faster Exact Exchange for Solids via occ-RI-K: Application to Combinatorially Optimized Range-Separated Hybrid Functionals for Simple Solids Near the Basis Set Limit

In this work, we developed and showcased the occ-RI-K algorithm to compute the exact exchange contribution in density functional calculations of solids near the basis set limit. Within the gaussian planewave (GPW) density fitting, our algorithm achieves a 1-2 orders of magnitude speedup compared to conventional GPW algorithms. Since our algorithm is well-suited for simulations with large basis sets, we applied it to 12 hybrid density functionals with a large uncontracted basis set to assess their performance on band gaps of 26 simple solids near the basis set limit. The largest calculation performed in this work involves 3456 electrons and 75600 basis functions utilizing a 6$\times$6$\times$6 k-mesh. With 20-27% exact exchange, global hybrid functionals (B3LYP, PBE0, revPBE0, B97-3, SCAN0) perform similarly with a root-mean-square-deviation (RMSD) of 0.60-0.76 eV while other global hybrid functionals such as M06-2X (1.98 eV) and MN15 (1.03 eV) show higher RMSD due to their increased fraction of exact exchange. A short-range hybrid functional, HSE achieves a similar RMSD (0.74 eV) but shows a noticeable underestimation of band gaps due to the complete lack of long-range exchange. We found that two combinatorially optimized range-separated hybrid functionals, $\omega$B97X-rV (3.86 eV) and $\omega$B97M-rV (3.34 eV), and the two other range separated hybrid functionals, CAM-B3LYP (2.36 eV) and CAM-QTP01 (4.08 eV), significantly overestimate the band gap because of their high fraction of long-range exact exchange. Given the failure of $\omega$B97X-rV and $\omega$B97M-rV, we have yet to find a density functional that offers consistent performance for both molecules and solids. Our algorithm development and density functional assessment will serve as a stepping stone towards developing more accurate hybrid functionals and applying them to practical applications

The facilitators of communication with people with dementia in a care setting: an interview study with healthcare workers

Objectives: to describe the views of healthcare workers on the facilitators of communication with people with dementia in a care setting. Design: thematic analysis of semi-structured interviews. Setting: all participants were interviewed in their place of work. Participants: sixteen healthcare workers whose daily work involves interacting with people with dementia. Results: four overarching categories of themes were identified from the interviews that impact on communication: the attributes of a care worker, communication strategies used, organisational factors and the physical characteristics of the care environment. Conclusion: many strategies used by healthcare workers to facilitate communication have not yet been studied in the research literature. Participants’ views on training should be incorporated into future dementia training programmes

Symptoms of mood disorders in family carers of older people with dementia who experience caregiver burden: a network approach

Background: Informal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden. Methods: Sixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale.The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions. Results: The resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression. Conclusions: This network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europ

Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine

Background: There is global concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field - in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective: To explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design: An online survey was sent to all UK higher medical trainees in geriatric medicine. Methods: Survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results: 269 responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions: There are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take

Factors related to medical students’ and doctors’ attitudes towards older patients: A systematic review

Background:Studies have sought to identify the possible determinants of medical students’ and doctors’ attitudes towards older patients by examining relationships with a variety of factors: demographic; educational/training; exposure to older people; personality/cognitive; and job/career factors. This review collates and synthesises these findings. Methods: An electronic search of ten databases was performed (ABI/Inform, ASSIA, British Nursing Index, CINAHL, Informa Health, Medline, PsycINFO, Science Direct, Scopus, and Web of Science) through to 7 February 2017. Results: The main search identified 2332 articles; 37 studies met the eligibility criteria set. All included studies analysed self-reported attitudes based on correlational analyses or difference testing, therefore causation could not be determined. However, self-reported positive attitudes towards older patients were related to: (i) intrinsic motivation for studying medicine; (ii) increased preference for working with older patients; and (iii) good previous relationships with older people. Additionally, more positive attitudes were also reported in those with higher knowledge scores but these may relate to the use of a knowledge assessment which is an indirect measure of attitudes (i.e. Palmore’s Facts on Aging Quizzes). Four out of the five high quality studies included in this review reported more positive attitudes in females compared to males. Conclusion:This paper identifies factors associated with medical students’ and doctors’ positive attitudes towards older patients. Future research could bring greater clarity to the relationship between knowledge and attitudes by using a knowledge measure which is distinct from attitudes and also measures knowledge that is relevant to clinical care

Development of a Malaysian Undergraduate Geriatric Medicine Curriculum

Objective: Malaysia is only beginning to age in 2020, but is expected to do this at an unprecedented rate in the next two decades. We aim to develop a national curriculum for undergraduate geriatric medicine in Malaysia to ensure future doctors are adequately equipped to address the healthcare needs of our older population. Method: The draft curriculum was developed by the Malaysian Society of Geriatric Medicine through literature review and mapping to the Malaysian Accreditation Guidelines for Undergraduate Medical Programme 2015. The curriculum was then refined through a modified Delphi process which involved 15 expert panel members each from Malaysia, Australia and the United Kingdom. Results: A total of three Delphi rounds were conducted. Five out of seven invited panellists agreed to participate in the first Delphi round. A larger group was invited via e-mail and fifteen panellists agreed to participate in Delphi rounds two and three, which resulted in 75 and 15 comments respectively. The final document with 34 learning outcomes was accepted with 80% agreement and consisted of detailed objectives grouped under 10 overarching core topics. Conclusion: Following consensus agreement determined through a Delphi process, a Malaysian undergraduate curriculum for geriatric medicine, aligned with the Malaysian Accreditation Guidelines, has been developed and will be shared with the 32 medical colleges in Malaysia to determine the current level of, and barriers to delivery

Mixture modeling of microarray gene expression data

About 28% of genes appear to have an expression pattern that follows a mixture distribution. We use first- and second-order partial correlation coefficients to identify trios and quartets of non-sex-linked genes that are highly associated and that are also mixtures. We identified 18 trio and 35 quartet mixtures and evaluated their mixture distribution concordance. Concordance was defined as the proportion of observations that simultaneously fall in the component with the higher mean or simultaneously in the component with the lower mean based on their Bayesian posterior probabilities. These trios and quartets have a concordance rate greater than 80%. There are 33 genes involved in these trios and quartets. A factor analysis with varimax rotation identifies three gene groups based on their factor loadings. One group of 18 genes has a concordance rate of 56.7%, another group of 8 genes has a concordance rate of 60.8%, and a third group of 7 genes has a concordance rate of 69.6%. Each of these rates is highly significant, suggesting that there may be strong biological underpinnings for the mixture mechanisms of these genes. Bayesian factor screening confirms this hypothesis by identifying six single-nucleotide polymorphisms that are significantly associated with the expression phenotypes of the five most concordant genes in the first group