Reach and adoption of a Geriatric Emergency Department Accreditation program in the United States

STUDY OBJECTIVE: The objectives of this study were to describe the reach and adoption of Geriatric Emergency Department Accreditation (GEDA) program and care processes instituted at accredited geriatric emergency departments (EDs). METHODS: We analyzed a cross-section of a cohort of US EDs that received GEDA from May 2018 to March 2021. We obtained data from the American College of Emergency Physicians and publicly available sources. Data included GEDA level, geographic location, urban/rural designation, and care processes instituted. Frequencies and proportions and median and interquartile ranges were used to summarize categorical and continuous data, respectively. RESULTS: Over the study period, 225 US geriatric ED accreditations were issued and included in our analysis-14 Level 1, 21 Level 2, and 190 Level 3 geriatric EDs; 5 geriatric EDs reapplied and received higher-level accreditation after initial accreditation at a lower level. Only 9 geriatric EDs were in rural regions. There was significant heterogeneity in protocols enacted at geriatric EDs; minimizing urinary catheter use and fall prevention were the most common. CONCLUSION: There has been rapid growth in geriatric EDs, driven by Level 3 accreditation. Most geriatric EDs are in urban areas, indicating the potential need for expansion beyond these areas. Future research evaluating the impact of GEDA on health care utilization and patient-oriented outcomes is needed

Clinical predictors of inflammatory bowel disease in a genetically well-defined Caucasian population

<p>Abstract</p> <p>Background</p> <p>Crohn's disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), are multifactorial conditions of unknown etiology. The objective of this study is to examine the combined gene-environment interactions influencing IBD susceptibility in a well-defined Caucasian cohort in rural mid-America.</p> <p>Methods</p> <p>Patients were diagnosed to have CD or UC using conventional radiologic, endoscopic, and/or histopathologic findings. Histological diagnosis was made by a single specialist gastrointestinal pathologist with a particular interest in IBD. Information regarding cigarette smoke exposure was obtained by administration of the Behavioral Risk Factor Surveillance System Survey (BRFSS) to all patients. Genomic DNA was extracted from peripheral blood leukocytes, and polymerase chain reaction (PCR) amplification and genotyping were performed for 11 Single Nucleotide Polymorphisms (SNP) in <it>NOD2</it>, <it>IL23r</it>, <it>OCTN1 </it>genes along with <it>IGR</it>.</p> <p>Results</p> <p>Our cohort consists of 1196 patients: 435 controls, 485 CD patients, and 276 UC patients. Only patients with genotype data for at least 7 of 11 SNPs were included in our data analysis. The control groups for all 11 SNPs were in Hardy-Weinberg Equilibrium. In genotype-association SNP analysis, all <it>NOD2 </it>SNPs (rs5743293, rs2066844, rs2066845) and the <it>IL23r </it>SNP (rs11465804) showed a significant association to IBD (<it>p </it>< 0.03). A multiple gene-interaction analysis showed an association between <it>NOD2 </it>and <it>IL23r </it>with UC (<it>p </it>= 0.04). There were no associations between any <it>OCTN1 </it>and <it>IGR </it>SNPs and IBD in this cohort. A multivariable logistic regression analysis showed that female gender, "current" or "former" smoking status, family history of IBD, and <it>NOD2 </it>SNP minor alleles were associated with CD.</p> <p>Conclusion</p> <p>IBD remains to be challenging to properly diagnose, characterize, and treat. Our study proposes a combined genetic, phenotypic, and environmental approach in an attempt to better understand IBD. Previously demonstrated associations between OCTN1 and IGR and IBD were not confirmed.</p

Madaris in Pakistan: Religious and Social Challenges

Purpose: The nature and extent of religious and social challenges posed by the madaris have been studied by scholars on a micro level, but there is a need of methodologically investigating of the problems on a macro and global levels by using a multi-disciplinary and collaborative approach to readdress these issues. The purpose of this research paper is to find out the role of for causing militancy in Pakistan and to recommend measures/strategies for de-radicalization in Pakistan. Design/Methodology/Approach: Agenda setting, priming and farming theories were used in this study. Qualitative content analysis method was used in this study to analyze the editorial policy of these three newspapers. Findings: The results revealed that all these three newspapers gave significant coverage to the peace talks issue but Nation gave more coverage to the issue. Findings also revealed that Dawn and The News, most of the time showed neutral behavior but tilted towards unfavorable position regarding peace talks. Nation showed strongly unfavorable behavior regarding peace talks. Implications/Originality/Value: So it is concluded that the government should take steps to take madaris in main stream education system in Pakistan. The funding should be checked and audited

Level of Comfort in Evaluating Older Patients Amongst Medical Students and Emergency Medicine Residents

Introduction As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM). Methods We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, in addition to exploring GEM education and interest. Results 169 trainees participated in the survey, 71% of which were medical students and 29% of which were residents. A majority of medical students (66%) and residents (92%) overall reported comfort evaluating and managing older patients in the ED, but comfort varied with each competency domain. Year of training within these groups was not reliably predictive of increased comfort across the various domains. Common barriers to learning more about GEM identified include exposure in medical education and training for medical students and residents, at 59% and 65% respectively. Medical students also noted that more exposure in preclinical and clinical training would increase interest in GEM, at 57% and 54%, respectively. For residents, learning more about what a career in GEM looks like would increase interest in GEM (51%). Common resources used to learn about older patients were society guidelines for medical students (56%) and UpToDate for residents (82%). Only 30% of medical students noted that their medical school offers a dedicated geriatric curriculum, and medical students whose medical school offered a geriatrics curriculum reported more comfort in evaluating and managing older patients in the ED. Conclusion While the majority of trainees surveyed felt comfortable in the geriatric core competencies, increased geriatrics exposure in preclinical and clinical training could increase interest in GEM. Such exposure may be best accomplished earlier in medical training and will be important in creating a future EM physician workforce that is competent in caring for this complex and important patient population

Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments

Background: Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. Objective: The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs. Methods: This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We a priori selected 5 GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes. Results: A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls was the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. With respect to medication related protocols, medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses, protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function. Conclusion: This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeneity in how these care processes are implemented