Adapting the Planetary Health Report Card for Graduate Medical Training Programs

Background Leading medical organizations recognize climate change as an urgent threat to public health and social justice. Medical students created the Planetary Health Report Card (PHRC) to evaluate and spur climate action in medical schools. Graduate medical trainees lack a similar tool to evaluate and improve their training programs and institutions. Objective To adapt the PHRC to graduate medical education (GME) contexts and report preliminary validity evidence. Methods In 2023, based on literature review, we adapted the 2022 undergraduate medical PHRC metrics on curriculum and sustainability. We modified keywords in all PHRC domains to apply to GME. We recruited participants with expertise in planetary health, sustainability, and health equity affiliated with GME. Using a modified Delphi Panel method, we surveyed participants on adapted metric validity. We determined percent agreement among participants. Results We recruited 45 eligible participants, of whom 20 (44%) completed a first-round survey. Participants included a senior medical student, residents, fellows, faculty, and program directors from the United States, Canada, and the United Kingdom. Participants had a high level of agreement on metrics in the domains of curriculum, support for trainee-led initiatives, and sustainability. Some metrics in research and community engagement domains fell below the agreement threshold. Conclusions In the first round of a modified Delphi Panel survey, trainees and faculty agreed that metrics adapted from the PHRC are relevant to evaluating GME programs on planetary health, sustainability, and environmental justice

Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults.

ObjectivesTo investigate the prevalence, characteristics, and management of pain in older hospitalized medical patients.DesignMedical record aggregate review.SettingTertiary care hospital.ParticipantsIndividuals aged 65 and older admitted to the medicine service between November 28, 2014, and May 28, 2015.MeasurementsDemographic characteristics, comorbidity burden, pain characteristics, and analgesics during index hospitalization were assessed in individuals with moderate to severe pain (≥4 on 0-10 Numeric Pain Rating Scale).ResultsOf 1,267 patients admitted to the medicine service, 248 (20%) had moderate to severe pain on admission (mean age 75 ± 8, 57% female, 50% white). During hospitalization, most participants received opioids (80%) and acetaminophen (74%), and few received nonsteroidal antiinflammatory drugs (9%). Participants with chronic pain had less reduction in pain intensity score from admission to discharge than those without a history of chronic pain (mean change score 3.7 vs 4.9, p=.002) and were more likely to receive opioids, adjuvant analgesics, and other analgesics (all p<.05).ConclusionTwenty percent of older adults admitted to a general medicine service had moderate to severe pain. Further research about optimal pain management in hospitalized older adults, particularly those with chronic pain, is necessary to improve care in this population

Multimorbidity and Opioid Prescribing in Hospitalized Older Adults.

Background: Multimorbidity and pain are both common among older adults, yet pain treatment strategies for older patients with multimorbidity have not been well characterized. Objectives: To assess the prevalence and relationship between multimorbidity and opioid prescribing in hospitalized older medical patients with pain. Methods: We collected demographic, morbidity, pain, and analgesic treatment data through structured review of the electronic medical records of a consecutive sample of 238 medical patients, aged ≥65 years admitted between November 2014 and May 2015 with moderate-to-severe pain by numerical pain rating scale (range 4-10). We used the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) to assess multimorbidity and cumulative illness burden. We examined the relationship between morbidity measures and opioid prescribing at hospital discharge using multivariate regression analysis. Results: The mean age was 75 ± 8 years, 57% were female and 50% were non-White. Mean CIRS-G total score was 17 ± 6, indicating high cumulative illness burden. Ninety-nine percent of patients had multimorbidity, defined as moderate-to-extremely severe morbidity in ≥2 organ systems. Sixty percent of patients received an opioid prescription at discharge. In multivariate analyses adjusted for age, race, and gender, patients with a discharge opioid prescription were significantly more likely to have higher cumulative illness burden and chronic pain. Conclusion: Among older medical inpatients, multimorbidity was nearly universal, and patients with higher cumulative illness burden were more likely to receive a discharge opioid prescription. More studies of benefits and harms of analgesic treatments in older adults with multimorbidity are needed to guide clinical practice