Palliative care for the elderly - developing a curriculum for nursing and medical students

<p>Abstract</p> <p>Background</p> <p>Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels.</p> <p>In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper.</p> <p>Methods</p> <p>In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages.</p> <p>We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found.</p> <p>Results</p> <p>The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum.</p> <p>Conclusions</p> <p>The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.</p

Blocking human fear memory with the matrix metalloproteinase inhibitor doxycycline

Learning to predict threat is a fundamental ability of many biological organisms, and a laboratory model for anxiety disorders. Interfering with such memories in humans would be of high clinical relevance. On the basis of studies in cell cultures and slice preparations, it is hypothesised that synaptic remodelling required for threat learning involves the extracellular enzyme matrix metalloproteinase (MMP) 9. However, in vivo evidence for this proposal is lacking. Here we investigate human Pavlovian fear conditioning under the blood-brain barrier crossing MMP inhibitor doxycyline in a pre-registered, randomised, double-blind, placebo-controlled trial. We find that recall of threat memory, measured with fear-potentiated startle 7 days after acquisition, is attenuated by ~60% in individuals who were under doxycycline during acquisition. This threat memory impairment is also reflected in increased behavioural surprise signals to the conditioned stimulus during subsequent re-learning, and already late during initial acquisition. Our findings support an emerging view that extracellular signalling pathways are crucially required for threat memory formation. Furthermore, they suggest novel pharmacological methods for primary prevention and treatment of posttraumatic stress disorder.Molecular Psychiatry advance online publication, 4 April 2017; doi:10.1038/mp.2017.65

MICROBIAL DEGRADATION OF NICOTINE I. Achromobacter nicotinophagumn. sp.: Morphology and Physiology of

The destruction of nicotine by microorganisms has been investigated since Batham (1927) ob-served an increase in the nitrate content of soil to which nicotine had been added. He assumed that this increase was due to the conversion of the alkaloid to nitrate by soil bacteria. Faitelo-witz (1927) showed that the nicotine content of nonsterile tobacco extracts decreased on standing, and Weber (1935) obtained a similar effect in bacteriological media free of tobacco and tobacco extracts. The quantitative destruction of nicotine in a synthetic medium by individual species of bacteria was studied by Bucherer and Enders (1942). They isolated three organisms in pure culture and named them Bacterium nicotino-phagum, Bacterium nicotinovorum, and Bacterium nicotinobacter. Wada and Yamasaki (1953) reported destruction of nicotine by a microbe said to be a Pseudomonad. Further characteriza-tion of this organism and a number of others was performed by Tabuchi (1954), who classified them in the genera Pseudomonas, Xanthomonas, Achromobacter, Bacillus, and Bacterium. Abdel-Ghaffar (1953) isolated several strains of nico-tinophiles belonging to the Corynebacteriaceae from cigar tobacco. Sguros (1955) also obtained a number of isolates which he placed in the genus Arthrobacter (Conn and Dimmick, 1947). This paper describes several organisms which have been isolated in pure culture from tobacco seeds and from soil in which tobacco had grown. Three of these organisms resemble those pre-viously described in the literature, but two others are sufficiently different to warrant a detailed description