Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Frailty as a Long Term Condition?
Monday 10 November 2014
12noon – 12.45pm
Professor John Young
National Clinical Director for Integration & Frail Elderly, NHS England
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
Scott Letendre, MD, of the UC San Diego HIV Neurobehavioral Research Program, presents "Overview of HIV & Aging" for AIDS Clinical Rounds at UC San Diego
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Frailty as a Long Term Condition?
Monday 10 November 2014
12noon – 12.45pm
Professor John Young
National Clinical Director for Integration & Frail Elderly, NHS England
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality
Scott Letendre, MD, of the UC San Diego HIV Neurobehavioral Research Program, presents "Overview of HIV & Aging" for AIDS Clinical Rounds at UC San Diego
Predicting Trends in Preventive Care Service Utilization Impacting Cardiovasc...gpartha85
-To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database
-To predict the trends in cardiovascular preventive care services in a U.S. population
Grading rubric for Falls prevention program project PMargaritoWhitt221
Grading rubric for Falls prevention program project
Parameter Points awarded Points Comments
1. Name of program
included
10
2. Location
described (name
and type)
10
3. three evaluation
methods described
10
4. five interventions
stated and
described as to
benefit
10
5. Training needed
(patient, staff,
administration, etc.)
10
6. Items needed
10
7. Cost of all
elements of
program
10
8. Goals of the
program
10
9. Paper written
with regards to
grammar,
punctuation,
spelling, etc.
10
10. Complies with
rules of APA
10
Total 100%
Discuss how, as a leader, you can anticipate and overcome resistance to change in in the military (ARMY).
**Please use 2 APA citation.
FALLS
Andy Geller, MD
THE AMERICAN GERIATRICS SOCIETY
Geriatrics Health Professionals.
Leading change. Improving care for older adults.
AGS
MR. C
• 84-year-old man
• Status post quadriceps tendon repair
• Ambulating with cane
• Wife concerned about his risk of falls
Slide 2
MR. C
• Suspected falls since discharge
• Decreased activity level
• In chair most of the day
• Soon to get a scooter?
Slide 3
MR. C
• Formerly very active
• Gait unsteadiness
• Former boxer
• Veteran
Slide 4
MR. C:
PAST MEDICAL HISTORY
• Non insulin-dependent diabetes
• Hypertension
• Hypercholesterolemia
• Gout
• Obesity
• Insomnia
• Osteoarthritis
Slide 5
MR. C:
MEDICATIONS
• Metformin
• Benazepril
• Amlodipine
• Allopurinol
Slide 6
MR. C:
PHYSICAL EXAMINATION
• BP 175/90, HR 65 (supine); BP 152/85, HR 68
(standing)
• Fingerstick blood glucose 380
• Normal heart and lung exams
• Normal abdominal exam (obese contours)
Slide 7
MR. C:
PHYSICAL EXAMINATION
• Visual impairment
• Bilateral sensory loss in feet
• Unchanged manual muscle testing
• Right knee crepitus
• Difficulty arising from seated position
Slide 8
MR. C:
FURTHER HISTORY
• The patient’s wife reports he hasn’t been
sleeping well of late
• On further questioning, the patient admits to
feeling “sorry” for his Army buddies, “who are
all gone now…and I don’t have much time left
myself”
Slide 9
QUESTIONS
• Can you identify at least 4 risk factors in this
patient for falling?
• Would a scooter be appropriate for this
patient?
• Can you suggest a different assistive device
for this patient?
Slide 10
Answers: Can you identify at least
4 risk factors in this patient for falling?
• Unsteadiness of gait after quadriceps tendon rupture
• Comorbid arthritis/gout
• Impaired balance due to diabetic neuropathy
• Obesity and deconditioning
• 4+ medications
• Orthostasis
• Decreased visual acuity
• Depressive symptoms
• Possible cognitive impairment due to boxing history
• Abnormal “Get Up and Go” test
• History of pri ...
| Jose Poulose | Preventive health services by Dr jose poulose |Dr. Jose Poulose
Doctors of internal medicine concern on adult medicine and also had special study and best training focusing on the prevention and treatment of adult diseases or sickness
Fall prevention for the Elderly Population | VITAS HealthcareVITAS Healthcare
The goal of this presentation is to learn the reasons for falls and to develop effective fall prevention strategies.
Objectives:
- Describe the incidence of falls in the elderly patient
- Define conditions contributing to falls
- Identify risk factors related to falls
- Explain and complete the basic fall assessment
- Describe the team approach to reduce falls
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
Running head EPIDEMIOLOGICAL AND NEEDS ASSESSMENT .docxsusanschei
Running head: EPIDEMIOLOGICAL AND NEEDS ASSESSMENT 1
EPIDEMIOLOGICAL AND NEEDS ASSESSMENT 6
Epidemiological and Needs Assessment
Student’s name:
Course:
Tutor:
Date:
Epidemiological Assessment in Union County Georgia
Chronic diseases are the leading causes of morbidity and death in union County Georgia. Some of the chronic diseases that lead in death rates include heart disease, stroke, cancer, diabetes, and chronic respiratory diseases. Obesity is a serious health concern the increases the risk of other chronic diseases (CHRR, 2014). A good proportion of UCG’s population is obese with about 30% of adults 18 years and older being obese and about 12% of high school student aged between 14-18 years. Among the chronic diseases, cardiovascular disease was the leading cause of death accounting for about 35% of all deaths in Union County Georgia. Death rates resulting from cardiovascular disease were high among men than among women and higher for blacks than for whites (CHRR, 2014). Most of those who died from these diseases were also below the age of 65. Generally speaking of all the chronic diseases then females were likely to suffer more than one chronic disease than the males. Adults with public health insurance were also more likely to suffer one or more of the chronic diseases.
Most of the chronic diseases are caused by lifestyle people choose to live or by their preferred diets. Diet and eating habit are risk factors for most of these chronic diseases and therefore must be looked into. Taking obesity and stroke for instance, they are both caused by taking high fat foods and lack of physical exercise (OMMQT, 2014). High fat foods are usually cheap and readily available thus the habit of taking high fat foods often can be attributed to laziness or low socio economic status to afford the healthy food on a daily basis. Smoking lack of physical exercise, poor eating habits, obesity and diabetes are all risk factors for most of the chronic diseases which results in death and morbidity. Some of the cardiovascular diseases that often lead to hospitalization include heart disease, type II diabetes and stroke with heart disease being the reason for a majority of chronic diseases admissions.
Cancer is also a major cause of death in Union County Georgia and is among the chronic diseases. Cancer is caused by so many factors but still diet comes in among the many factors some of which include the genetics. Among the residents of Georgia there are about 100 new diagnosis of cancer reported daily with the exception of skin cancer and carcinoma. Prostate cancer among men and breast cancer in women are the leading types of cancer diagnosed in this community (UCB, 2014). Leukemia cases are the least heard of though they also exist among the residents here.
Health Needs As ...
Critical Appraisal of a Diagnostic Test Article.pptxMarc Evans Abat
How to critically appraise a journal article on accuracy of a diagnostic test. This presentation spans issues regarding directness, validity, applicability and individualization. Also included are how to process information on sensitivity, specificity, likelihood ratios, predictive values and decision thresholds
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
1. M A R C E V A N S M . A B A T , M D , F P C P , F P C G M
H e a d , C e n t e r f o r H e a l t h y A g i n g
THE ELDERLY PATIENT
WITH FALL
2.
3. • Leading cause of
mortality, injury,
hospitalization and
disability
• 1 in every 4 elderly
• In 2014, $31 billion as
cost of injuries
Why are falls important?
https://www.ncoa.org/news/resources-for-
reporters/get-the-facts/falls-prevention-facts/
4. Relative Risk
1. Muscle weakness 4.4
2. History of falls 3.0
3. Gait deficit 2.9
4. Balance deficit 2.9
5. Use of assistive device 2.6
6. Visual deficit 2.5
7. Arthritis 2.4
8. Impaired daily living activities 2.3
9. Depression 2.2
10.Cognitive impairment 1.8
11.Age > 80 years 1.7
What causes falls?
American Geriatric Society Panel on Falls Prevention,
Journal of the American Geriatric Society, 2001
5.
6.
7. Falls and Medications
• More medications
(polypharmacy),
the higher the fall
risk
• Stronger
relationship with
medications that
can cause falls
http://bmjopen.bmj.com/content/7/10/e016358
Nurs Midwifery Stud. 2013 Jun; 2(2): 171–175.
10. • 30-day mortality higher in the
nonoperative group with odds ratio [OR]:
3.95, 95% confidence interval [CI]: 1.43-
10.96;
• 1-year mortality OR: 3.84, 95% CI: 1.57-
9.41
Complications of Non-Operative
Treatment
http://journals.sagepub.com/doi/full/10.1177/
2151458517713821
11. • Prevent the 1st fall
• Prevent future falls
• Prevent complications of
falls
• Treat the complications
• Rehabilitate to prevent the
disability
• Manage what can be
managed
How to manage?
12. • Detailed History
• Physical and Neurological
Examination
• Cognitive Evaluation
• Behavioral/Emotional
Evaluation
• Functional Evaluation
• Nutritional Evaluation
• Environmental Evaluation
• Social Evaluation
13. • The USPSTF does not recommend
automatically performing an in-depth
multifactorial risk assessment in
conjunction with comprehensive
management of identified risks to prevent
falls in community-dwelling adults aged 65
years or older because the likelihood of
benefit is small. (Grade C)
Screening for Falls
14. •BUT…..patients and clinicians
should consider the balance of benefits
and harms on the basis of the
circumstances of prior falls, comorbid
medical conditions, and patient values.
16. Timed Up and Go Test
• Prepare the following
– Armless chair
– A marker 10 feet away from the chair
• Procedure
10 ft.
Rise from chair Walk to the marker on the floor TurnReturn to the chairSit down again
18. • In women aged 65 years and older and in
younger women whose fracture risk is
equal to or greater than that of a 65-year-
old white woman who has no additional
risk factors (Grade B)
Osteoporosis Screening
USPSTF
20. • Rule out secondary causes
• Pharmacologic
– Bisphosphonates
– SERMs
– Teriparitide
– Strontium ranelate
– Denosumab
– Calcium and Vitamin D
• Rehabilitation
Osteoporosis Treatment
21. • Early surgical intervention (within 24
hours)
– significantly lower 30-day mortality (5.8% vs.
6.5%; number needed to treat [NNT], 127)
– fewer postoperative complications (i.e.,
myocardial infarction, pneumonia, or venous
thromboembolism)
– significantly fewer adverse outcomes at 30
days (10% vs. 12%; NNT, 48).
Surgical Management
https://www.jwatch.org/na45700/2018/01/02
/timing-hip-fracture-repair
22. • Cardiac perioperative evaluation
– Weighing risks vs. benefits
• DVT and VTE prophylaxis
Perioperative Management
23. • improved ambulatory outcomes
• improved functional recovery
• improved strength and balance recovery
• decreased length of stay and increased falls
self-efficacy
• positive effect on lower-extremity power
generation
Rehabilitation after Hip Surgery
Arch Phys Med Rehabil. 2009 Feb;90(2):246-
62. doi: 10.1016/j.apmr.2008.06.036.
24. • Nutritional management
• Optimization of other medical conditions
• Pain management
Other Aspects of Care