Larger Proportion Of Residents Research Articles

Curriculum Innovations: Implementing a Neuropalliative Care Curriculum for Neurology Residents

Background and Objectives Neuropalliative care is an emerging interprofessional field that aims to improve communication and quality of life for all people affected by serious neurologic disease. Teaching neuropalliative care skills is a key objective for neurology residencies, and the Accreditation Council for Graduate Medical Education requires proficiency in palliative care. The objective of this study was to describe a novel longitudinal multimodal curriculum in neuropalliative care communication and evaluate its feasibility and outcomes. Methods and Curriculum Description We designed a multimodal curriculum focused on neuropalliative care communication skills using as our theoretical foundation transformative learning theory. We implemented this program for neurology residents at a single academic institution over the course of their 3-year training. Residents underwent (1) 3 communication workshops using VitalTalk modules and simulated patient encounters, (2) 3 or more observed clinical encounters with structured faculty feedback, and (3) at least 3 annual neuropalliative care lectures. We evaluated the effect on learners' self-assessed confidence in neuropalliative care skills with preworkshop and postworkshop questionnaires. Results and Assessment Data In 2021, 14 of 20 eligible residents attended our workshops and completed the preworkshop questionnaire, and 12 of those completed the postworkshop questionnaire. After the workshop, a larger proportion of residents (75%, 9/12) agreed or strongly agreed that they felt confident leading family meetings compared with before the workshop (57%, 8/14). While more than 90% of residents felt confident recognizing patient and family emotions both before and after the workshop, the workshop improved their confidence in responding to such emotions. Still, some residents neither agreed nor disagreed (42%, 5/12) about feeling confident in responding to emotions after the workshop, and many commented on wanting more training in this area. Discussion and Lessons Learned The successful implementation and high attendance among eligible participants demonstrate the feasibility of our longitudinal multimodal neuropalliative care curriculum. The evaluation of intervention outcomes suggests that residents' confidence in neuropalliative communication skills improved. Our study shows that VitalTalk is a tool that can be adapted to teach neuropalliative communication skills for neurology residents, and this program can be easily adopted by other neurology training programs.

Understanding the study habits of Saudi residents in a psychiatry programme

ObjectivesUnderstanding the way psychiatry residents select, consume, and prioritise their educational resources during their psychiatry residency programme is essential. The purpose of this study was to evaluate Saudi psychiatry residents' study habits during their residency training. MethodsIn this cross-sectional study, 150 Saudi psychiatry residents were invited to complete an anonymous survey with 18 close-ended statements. The responses were recorded on a 5-point Likert scale. The survey included items about study volume, motivational factors, study resources, study methods, and overall satisfaction with training. ResultsWe received responses from 121 residents. There were more men (57.9%) than women (42.1%). A larger percentage of residents studied between two and five hours per day (30.6%). A larger proportion of residents did not agree that the psychiatry residency programme had some degree of protected time prior to their board exams (42.2%). The most crucial motivating factor for their study was the final board exam; 28.1% and 35.5% of residents ranked this factor as highly and very highly motivating, respectively. The most useful study resources were books such as Kaplan, Oxford, and Oral Board materials. ConclusionOur study is the first of its kind that provides insight into the study habits of Saudi psychiatry residents. The information can be used to improve the quality of training and medical education of psychiatry residents.

Swallowing difficulty and nutrient intakes among residents in assisted living facilities in Helsinki

BackgroundSwallowing difficulty (SWD) commonly occurs and is associated with malnutrition in old age. Less is known of how SWD is associated with various nutrient intakes. ObjectivesTo examine how SWD among residents in assisted living facilities. Materials and methodsIn this cross-sectional study, we examined 345 residents in Helsinki in 2007. Detailed energy, protein and nutrient intakes were calculated from 1-day food diaries and compared with the Nordic Nutrition Recommendations (NNRs) as a measure of dietary adequacy. Swallowing was assessed by the closest nurse knowing the resident well. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). ResultsOf the participants, 14% (n=48) suffered from SWD, often had prior stroke, increased comorbidities and lower body-mass index. A larger proportion of residents with SWD consumed oral nutritional supplements. The MNA showed that over 52% of residents with SWD were malnourished, whereas the respective figure was 17% among residents without SWD. A large proportion of the study population had lower than recommended intakes of energy, protein and micronutrients. However, those with SWD differed significantly from those without only in higher protein and lower zinc and folic acid intakes. ConclusionAlthough malnutrition was more common among those with SWD than those without, the daily intakes of energy, protein and micronutrients were similar in these groups, highlighting that the risk of malnutrition and low nutrient intakes commonly occurred in both groups of residents in assisted living facilities.

Potentially severe drug–drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study

Objective: This study aims to assess potentially severe class D drug–drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug–drug interaction database (SFINX).Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland.Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX.Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents.Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N = 78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p < 0.001). A larger proportion of residents with DDDIs suffered from rheumatoid arthritis or osteoarthritis than those not exposed to DDDIs (24.7% vs. 15.4%, p = 0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N = 12) or spironolactone (N = 12). Carbamazepine (N = 13) and methotrexate (N = 9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs.Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs.KEY POINTS Potentially severe, class D drug–drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided. • Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs. • The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs. • No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

Households? Awareness and Perception of Sanitation Bye-Laws in Ghana: Evidence from Kumasi Metropolis

The study seeks to assess households' perception and satisfaction for the current waste management system and to evaluate the level of awareness and attitude of households towards sanitation bye-laws within the Kumasi Metropolis. Data for the study was collected from secondary and primary sources. Questionnaire was employed in gathering the primary data. Statistical Package for Social Sciences (SPSS) was used to analyze it. The study revealed that the residents are not happy with the current sanitation situation within the metropolis. A large proportion of the respondents are not aware of the sanitation bye-laws of the Assembly. Furthermore, the study revealed that the frequency of waste collection is very low resulting in piles of waste in secondary receptacles which can lead to health hazards. The study recommended the need for the assembly to step up her efforts to educate residents within the metropolis on the sanitation bye-laws. Abridged versions of the bye-laws could be printed in both English and Twi languages and distributed to residents, as well as being published on the Assembly's website for easy access by internet users. It is also important that the KMA empower and motivate waste collection companies to improve their efficiency, expand their coverage to reach out to the entire city and get larger proportion of residents to subscribe to the private waste collection system.

A descriptive study of older bipolar disorder residents living in New York City’s adult congregate facilities

Much of the research on geriatric bipolar disorder is from outpatient populations or epidemiological surveys with small samples. In contrast, in this study a descriptive analysis was conducted of geriatric and younger adult residents with bipolar disorder or mania in non-clinical adult congregate facilities (ACFs) in the greater New York City region. A total of 2602 ACF residents were evaluated in 19 facilities, across multiple demographic and health domains. Within this sample, 200 residents had chart diagnoses of bipolar disorder or mania. Among these, 50 geriatric residents (age ≥ 60) were compared to 50 younger adult residents (age < 50) on a number of demographic and health measures. Based on chart diagnoses, the overall prevalence of bipolar disorder was 7.8%. Compared to other studies of outpatient, epidemiological, and census samples, both older and younger residents with bipolar disorder had higher rates of cognitive impairment, impairment in executive functioning, vision impairment, and proportion of residents who had never been married. The younger group also had higher rates of obesity and the elderly group had a greater proportion of residents without high-school education. Both age groups had rates of lithium or valproate use comparable to those found in outpatient studies. Comparing the two age groups, the elderly sample had lower overall cognitive and executive functioning, and was using a larger number of medication classes than the younger group. The elderly group also had a larger proportion of residents who were separated/divorced or widowed compared to the younger group, which had higher rates of never-married residents. Overall, both age groups had relatively high rates of bipolar disorder, with significant cognitive impairment, medical burden, obesity, mental health service use, and lower education levels, as compared to outpatient, epidemiological, and census samples. Of note was the significant cognitive impairment across age groups.

Rapid Communication: Sociodemographic Differences between Counties with High and Low Utilization of a Regional Poison Control Center

A retrospective review of data from the New Jersey Poison Information and Education System (NJPIES) was conducted to determine whether differences exist in the sociodemographic characteristics between counties with high or low utilization of the regional poison control center (PCC). The goal was to generate hypotheses about the potential reasons for the variances in the utilization rates by different subpopulations, in order to develop culturally sensitive educational and preventive strategies in an effort to enhance the use of PCC services. Data from the NJPIES 2002 computerized medical records were analyzed to estimate the utilization rates (number of calls to NJPIES per 1000 of population) for each county in New Jersey. This information was then combined with county sociodemographic data from the 2000 U.S. Census. Sociodemographic characteristics were compared between the counties with high and low utilization rates and statistically significant differences were found. Counties with low utilization of PCC had significantly higher population density per square mile, smaller proportion of White residents, larger proportion of residents of "other race," and larger proportion of Black, Asian, and Hispanic and Latino residents. Further study is needed to examine the underlying reasons for the underutilization of PCC among such populations and to explore methods for improving their awareness and use of the services provided by PCC.