Publications

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JAMDA
March 1, 2016

Reducing polypharmacy is a priority of CMS and AMDA. The Indiana State Department of Health (ISDH) has approved a collaborative proposal that will build an innovative infrastructure of quality improvement (QI) and formally engage nursing home physicians and medical directors through IMDA, Indiana Society of Post-Acute and Long-Term Care Medicine (IMDA), to address polypharmacy.

JAMDA
March 1, 2016

Amiodarone is a potent antiarrhythmic which is effective for maintaining sinus rhythm but with potentially disabling side effects. There are well known black-box warnings associated with its continued use: sudden death and deadly side effects including pulmonary toxicity, hepatotoxicity and proarrhythmia. The North American Society of Pacing and Electrophysiology (NASPE) have specific guidelines for its continued usage. Residents in our 720 bed post-acute and long-term care facility are admitted and maintained on this agent but there is no data about how well they are monitored.

JAMDA
March 1, 2016

Teaching family practice resident physicians to perform a quality transition of care upon hospital discharge is an important and common skill. It is an area of medicine that has been shown in studies to be prone to communication and medical errors which affect patient care and can lead to readmissions. Within our own residency, a need to improve our curriculum was identified. It was decided to integrate an interprofessional team approach and home visits into this educational experience.

JAMDA
March 1, 2016

In recent years, the SNF/LTC Industry has seen the demand for its services increase. This has been due in part to a shift in population demographics as well as to financial incentives for hospitals to reduce patient stays. This is driving the need for more doctors with the skills necessary to care for the elderly in the SNF environment. Being part of a small medical community with a newly established family medicine residency program, we have elected to partner with our local SNF's to engender within our Family Medicine Residents an understanding for SNF/LTC care and the need for...

JAMDA
March 1, 2016

In anticipation of the changes required of our health care system to support a growing population of older adults, a geriatric pharmacy initiative designed to foster interest in geriatrics and long term care (LTC) as well as inter-professional collaboration was introduced at the Barrie Royal Victoria Regional Health Centre (RVH) Family Medicine Residency Program. The initiative involved a pharmacist-led half-day practicum in a LTC home and pharmacy with the goal of creating a positive work experience that would nurture a passion for geriatric medicine in upcoming physicians as well...

JAMDA
March 1, 2016

The objective for this study is to assess our physicians in training competency with regard to communicating with older patients. We present needs assessment survey results, curriculum development, and proposed implementation.

JAMDA
March 1, 2016

Medicare requires skilled medical facilities to have a medical director. The presence of medical directors in a facility has been shown to enhance the quality of care delivered to the residents of these facilities. Thus it is important that Geriatric fellows be prepared to assume this role upon graduation. The University of Maryland Geriatric Fellowship provides Geriatric Training at a variety of clinical settings. The fellow's long-term care (LTC) experience for the past 4 years has been limited to a longitudinal nursing rotation at a VA Community Living Center (CLC).

JAMDA
March 1, 2016

Valproic acid (VPA) is commonly prescribed to treat epilepsy, bipolar disorder & migraine headaches. Though it has been associated with numerous adverse events, its effects on speech & one's ability to articulate has not been thoroughly studied. We report here an interesting case of VPA induced aphasia in a post stoke patient.

JAMDA
March 1, 2016

Warfarin is a commonly prescribed medication for patients in the post-acute or long-term care setting for conditions such as acute deep venous thrombosis (DVT), pulmonary embolus, or atrial fibrillation. Warfarin induced skin necrosis (WISN) has high rates of complications including acute severe anemia, hemorrhagic bullae, and life threatening wounds. Early recognition is critical in managing potential complications.

JAMDA
March 1, 2016

Orthostatic hypotension (OH) is common, affecting up to 30% of the general population over 65 and up to 70% of people living in nursing homes. It is defined by a drop in the systolic blood pressure (BP) of 20 mmgh or/and diastolic BP of 10 within 3 min of standing. Neurogenic orthostatic hypotension is a type of OH caused by autonomic failure and multiple system atrophy. It is relatively common condition associated with disorders affecting central or peripheral pathways of the baroreflex. One of the challenges in treating OH is the side effect of supine hypertension with the conventional...