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Being protected from the stressful everyday routine: experiences of the subsequent of kin to folks together with dementia joining farm-based child care.
Many general practitioners consider dementia care beyond their clinical domain and feel that dementia assessment and treatment should be addressed by specialists, such as geriatricians, geriatric psychiatrists, or neurologists. An urgent need exists to educate all medical trainees in dementia care, regardless of their specialization interests.

We developed a multicomponent, experiential, brief curriculum using team-based learning to expose senior medical students who rotated through the US Department of Veterans Affairs Memory Disorders Clinic at the Central Arkansas Veterans Healthcare System in Little Rock to an interdisciplinary assessment of dementia. The curriculum included didactics, clinical experience, and team-based learning. In pre- and postevaluation, students rated their perception of the role of interdisciplinary team members in assessing and managing dementia, their personal abilities to assess cognition, behavioral problems, caregiver burden, and their perception of the impact of behavioral problems on dementia care.

Dementia knowledge gaps were prevalent in this cohort of senior medical students. Providing interdisciplinary geriatric educational experience improved students perception of their ability to assess for dementia and their recognition of the roles of interdisciplinary team members. Plans are in place to continue and expand the program to other complex geriatric syndromes.
Dementia knowledge gaps were prevalent in this cohort of senior medical students. Providing interdisciplinary geriatric educational experience improved students perception of their ability to assess for dementia and their recognition of the roles of interdisciplinary team members. Plans are in place to continue and expand the program to other complex geriatric syndromes.
Antibiotics are one of the most frequently prescribed medications. Among all classes of antibiotics, penicillins are prescribed due to their clinical efficacy, cost-effectiveness, and general safety. Unfortunately, penicillins also are the most common drug allergy listed in patient medical records. Increasing evidence shows that > 90% of patients labeled with a penicillin allergy are not allergic to penicillins and associated β-lactams. The health care consequences of penicillin allergy in the setting of military medicine and readiness are important to consider.

In the US, 8 to 10% of the population and up to 15% of hospitalized patients have a documented penicillin allergy, limiting the use of these effective antibiotics. When treating a patient with a penicillin allergy, many clinicians avoid prescribing all β-lactam antibiotics and stay away from cephalosporins due to the concern for potential cross-reactivity. The cost of treating those with a documented penicillin allergy is greater than the cost ll portion have a true immune-mediated allergy. Given the clinical, public health, and economic costs associated with a penicillin allergy label, evaluation and clearance of penicillin allergies improves clinical outcomes, decreases AEs from higher risk alternative broad-spectrum antibiotics, and prevents the spread of antibiotic resistance. In military personnel, penicillin delabeling improves readiness with optimal antibiotic options and avoidance of unnecessary risks, expediting return to full duty.
This review of serotonin syndrome or serotonin toxicity covers the years 2014 to 2019, including information on pathophysiology, etiology, and diagnosis, 3 criteria for diagnosing serotonin syndrome, and criteria for neuroleptic malignant syndrome.

The review highlights the potential lethal combinations of commonly prescribed medications used to treat both veteran and nonveteran patients and includes the latest information on offending medications.

Prevention of serotonin toxicity includes informed clinicians, patient education, careful prescribing and monitoring, and avoidance of multidrug regimens.
Prevention of serotonin toxicity includes informed clinicians, patient education, careful prescribing and monitoring, and avoidance of multidrug regimens.
As a result of a cost savings initiative, the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, selected liraglutide as its preferred glucagon-like peptide 1 receptor agonist for the treatment of patients with type 2 diabetes mellitus with a preferred maximum daily dose of 1.2 mg. With this change, several veterans were converted from liraglutide 1.8 mg daily to 1.2 mg daily; however, the benefit of this change remains unknown. The objective of this study was to assess sustained glycemic control and cost savings that resulted from the liraglutide dose reduction.

A retrospective chart review was conducted to include veterans on liraglutide 1.8 mg daily and insulin and/or other antihyperglycemic agents who were converted to liraglutide 1.2 mg daily between May 2018 and August 2018. Demographic data, hemoglobin A
(HbA
), serum glucose levels, body weight, prescriber type, and medication history were obtained using the Computerized Patient Record System. Veterans' charts were evaluated y liraglutide treatment from 1.8 mg to 1.2 mg was associated with HbA1c increase, increased insulin requirements, and cost savings. A cost effectiveness analysis is needed to assess overall benefit of the liraglutide dose reduction initiative.
Two large major trials showed that long-term oxygen therapy (LTOT) improved mortality in patients with chronic obstructive pulmonary disease (COPD) and hypoxemia. Although oxygen accelerates combustion and is an obvious fire hazard, LTOT has traditionally been prescribed to veterans who are actively smoking.

We conducted a retrospective chart review of all veterans with COPD at a single center who were prescribed new LTOT between October 2010 and September 2015. Of the 158 patients who met the study criteria, 152 were male. Bayesian logistic regression was used to model the outcome variable fire-related incident with the predictors smoking status, age, race, depression, posttraumatic stress disorder, and type of oxygen used.

The mean age of the 158 patients with COPD in the study was 71.3 years in nonsmokers and 65.9 years in smokers. The model-estimated odds (SD) of a fire-related incident occurring in a smoker were 31.6 (5.1-372.7) times the odds of a fire-related incident occurring in a nonsmoker.

Patients who smoke and remain on LTOT put themselves at greater risk of having a fire-related incident than do nonsmokers.
Patients who smoke and remain on LTOT put themselves at greater risk of having a fire-related incident than do nonsmokers.Determining whether measures are equally valid for all individuals is a core component of psychometric analysis. Traditionally, the evaluation of measurement invariance (MI) involves comparing independent groups defined by a single categorical covariate (e.g., men and women) to determine if there are any items that display differential item functioning (DIF). More recently, Moderated Nonlinear Factor Analysis (MNLFA) has been advanced as an approach for evaluating MI/DIF simultaneously over multiple background variables, categorical and continuous. Unfortunately, conventional procedures for detecting DIF do not scale well to the more complex MNLFA. The current manuscript therefore proposes a regularization approach to MNLFA estimation that penalizes the likelihood for DIF parameters (i.e., rewarding sparse DIF). This procedure avoids the pitfalls of sequential inference tests, is automated for end users, and is shown to perform well in both a small-scale simulation and an empirical validation study.A multiplex PCR system has been developed and optimized for rapid detection of the five main pathogens of bacterial pneumonia. The system can be expanded to analyze viral pathogens of pneumonia (DNA- and RNA-containing viruses), as well as those of a fungal nature.Relative to younger adults, older adults have demonstrated higher emotional well-being in the face of the threats of COVID-19 (e.g., Bruine de Bruin in J Gerontol 10.1093/geronb/gbaa074, 2020) and other events (Bonanno and Diminich in J Child Psychol Psychiatry 54378-401, 2013). click here Thus, we predicted that levels of well-being would show minimal change in the first 4 months of COVID-19, with older adults faring better than younger adults. Adults (N = 325, M age = 39.7, SD = 12.3) were surveyed before the pandemic began and at four additional time points throughout the first 4 months of the COVID-19 outbreak in the United States. Participants provided demographic information and completed measures of positive and negative affect. Latent growth curves were used to analyze changes in well-being over time, with age as a covariate. There was a significant linear increase in positive affect. Older age was positively associated with initial levels, but age was not associated with the slope. There was a significant curvilinear pattern in negative affect, with an initial increase, which, although remaining elevated, exhibited slow decreases over time. Age was significantly and negatively associated with initial negative affect, but age did not influence the shape or rate of change over time. We detected changes in both positive affect and negative affect during the first 4 months of COVID-19. The magnitude of these changes suggests that the stress of COVID-19 does not lead to an immediate decrease in well-being. Moreover, although older adults showed higher positive affect and lower negative affect relative to other adults, age differences in the trajectory of change did not emerge. link2 Delayed and long-term effects on well-being and whether those effects are age-invariant should be examined over longer periods of time.Field analyzers for the measurement of lead in drinking water samples are gaining interest from states, water utilities and building managers as rapid, inexpensive and simple tools to quantify lead concentrations. This literature review compares data quality by field analyzers to established laboratory methods and provides practical information (e.g. costs, ease-of-use) on commercial lead analyzers that are based on (1) Electrochemistry, (2) Colorimetry and (3) Fluorescence. Between and within these three general field analyzer categories, manufacturers specify a variety of protocols to prepare the samples, which differ from the standard acidification in laboratory methods. Review of the literature raised concerns that without adequate sample preparation, field analyzers may not always fully quantify the total lead concentration, including particulate lead, thereby resulting in underestimations. Nonetheless, field analyzers have been used to quickly obtain experimental results in the laboratory, or in the field when access to laboratory equipment was limited, expensive or otherwise impractical. Field analyzers were also successfully used to detect lead from service lines, by a water utility where lead was mostly in the dissolved form. link3 Overall, intrinsic strengths and weaknesses of field analyzers are discussed, to better balance practical convenience and adequate data quality depending on the objective.Vascular interventionalists have long debated on whether one or multiple patent tibial arteries (run-off) are necessary to treat critical limb ischemia, including ischemic rest pain and tissue loss. This review article seeks to clarify data surrounding this topic by including literature from retrospective studies, prospective studies, meta-analyses, and randomized controlled trials. Our conclusion is that revascularizing a single tibial artery to the foot is adequate for wound healing.
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