Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings

Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals of care and medication management in both in-hospital and non-hospital settings. Residents rotated through both in-hospital and non-hospital settings as one block rotation. They took a test of geriatric learning before the rotation and then took the same test at the end of the rotation. Residents showed an improvement in several geriatric domains on completion of a combined in-hospital and non-hospital rotation curriculum. We concluded that the development and implementation of a combined rotation curriculum has practical application to resident learning and the potential to improve geriatrics care outside of hospital settings

The Lantern, 2021-2022

No More Buses through El Paso • A Woman\u27s World • The Angel of Tragedy • A Victim of Circumstance • Ace of Hearts • Ghost Light • Missing Diamonds • The Upside-Down House: A Dialogue with the Self • What is Chronic Pain? • A Sunny Day in Sinkhole • Extra Marshmallows • Fourth Wall Broken • Hemlock • In the Comfort of Others • Lasting Impressions • Let\u27s Do the Time Warp Again • One Last Afternoon • Space Invaders • The Dogwood Tree • An Ode to Poppies • Charlotte\u27s Web • Crab • Crossing • Dandelions • Dandelion Sandwich • Grizzly Hood • Help Wanted • I Gave Way • I\u27m not who you wanted but maybe one day I can be • Kneeling • Lemon Cookies • Lies • Method Acting • Moment of Tranquility • Our Home • Overthinking • Sea Glass • Seasonal • Thirty-Two (No Spares) • The Autumn Beast • The Miller\u27s Daughter • Theodore • To the Earring I Left Behind in Your Carpet • Virginia • Waltzing • Yellow House • 1/25 British Monarch • Cracked • In the Shadows • Jewelwing • Life on the Wing • O\u27 Captain my Captain • Stars Above the Bay • The Common Fall • Tom • Cats + Crowshttps://digitalcommons.ursinus.edu/lantern/1190/thumbnail.jp

Tracking CNS and systemic sources of oxidative stress during the course of chronic neuroinflammation

The functional dynamics and cellular sources of oxidative stress are central to understanding MS pathogenesis but remain elusive, due to the lack of appropriate detection methods. Here we employ NAD(P)H fluorescence lifetime imaging to detect functional NADPH oxidases (NOX enzymes) in vivo to identify inflammatory monocytes, activated microglia, and astrocytes expressing NOX1 as major cellular sources of oxidative stress in the central nervous system of mice affected by experimental autoimmune encephalomyelitis (EAE). This directly affects neuronal function in vivo, indicated by sustained elevated neuronal calcium. The systemic involvement of oxidative stress is mirrored by overactivation of NOX enzymes in peripheral CD11b(+) cells in later phases of both MS and EAE. This effect is antagonized by systemic intake of the NOX inhibitor and anti-oxidant epigallocatechin-3-gallate. Together, this persistent hyper-activation of oxidative enzymes suggests an "oxidative stress memory" both in the periphery and CNS compartments, in chronic neuroinflammation

A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients

BACKGROUND: Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium. METHODS: We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital. Patients from one intervention unit and two usual-care units were enrolled by means of a prospective matching strategy. The intervention consisted of standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Delirium, the primary outcome, was assessed daily until discharge. RESULTS: Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group, (matched odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.92). The total number of days with delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 90, P=0.03) were significantly lower in the intervention group. However, the severity of delirium and recurrence rates were not significantly different. The overall rate of adherence to the intervention was 87 percent, and the total number of targeted risk factors per patient was significantly reduced. Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients. Among the other risk factors per patient there were trends toward improvement in immobility, visual impairment, and hearing impairment. CONCLUSIONS: The risk-factor intervention strategy that we studied resulted in significant reductions in the number and duration of episodes of delirium in hospitalized older patients. The intervention had no significant effect on the severity of delirium or on recurrence rates; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy

Inflammasome-independent modulation of cytokine response by autophagy in human cells

Contains fulltext : 98007.pdf (publisher's version ) (Open Access)Autophagy is a cell housekeeping mechanism that has recently received attention in relation to its effects on the immune response. Genetic studies have identified candidate loci for Crohn's disease susceptibility among autophagy genes, while experiments in murine macrophages from ATG16L1 deficient mice have shown that disruption of autophagy increases processing of IL-1beta and IL-18 through an inflammasome-dependent manner. Using complementary approaches either inducing or inhibiting autophagy, we describe modulatory effects of autophagy on proinflammatory cytokine production in human cells. Inhibition of basal autophagy in human peripheral blood mononuclear cells (PBMCs) significantly enhances IL-1beta after stimulation with TLR2 or TLR4 ligands, while at the same time reducing the production of TNFalpha. In line with this, induction of autophagy by starvation inhibited IL-1beta production. These effects of autophagy were not exerted at the processing step, as inflammasome activation was not influenced. In contrast, the effect of autophagy on cytokine production was on transcription level, and possibly involving the inhibition of p38 mitogen activated protein kinase (MAPK) phosphorylation. In conclusion, autophagy modulates the secretion of proinflammatory cytokines in human cells through an inflammasome-independent pathway, and this is a novel mechanism that may be targeted in inflammatory diseases

A NOD for autophagy.

Contains fulltext : 89544.pdf (publisher's version ) (Closed access)1 januari 201