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Optimal hand hygiene practices reduce the risk of healthcare-associated infections, especially in high-risk settings of immunocompromised patients. In 2020, face-to-face learning was disallowed in the environment of coronavirus disease 2019 transmission. We developed a revised learning program for hand hygiene auditors for our cancer care facility. The learning package resulted in a 2-fold increase in the number of participants, with effective promotion by managers, due in part to reduced time and resources for training, and flexibility for staff.

Burnout in the social work field receives significant attention, yet existing literature has disregarded social work educators as an affected population. This research utilized Bronfenbrenner’s eco...

Tanulmányunkban a Szociális Munkás Empowerment Skála (Social Worker Empowerment Scale) magyar változatának kidolgozását, a hazai mérőeszköz validálási folyamatát, illetve a skála érvényességére vonatkozó empirikus adatfelvétel legfontosabb eredményeit mutatjuk be, elsősorban reliabilitás vizsgálatokra támaszkodva. A skála a gyakorlatban dolgozó szakemberek empowerment-szintjét hivatott mérni. Kutatásunk meggyőzően bizonyította, hogy a skála magyar változata valid, megfelelően működik, alkalmas arra, hogy a hazai kutatásokban is alkalmazásra kerüljön.

Objectives To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. Design This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. Setting The study took place in all nine acute care hospitals for adults in Louisville, KY. Participants Residents in the city of Louisville, KY, who were diagnosed with CAP between the inclusion dates were included and who were aged 65 years or older. Measurements Incidence of CAP and outcomes were measured. A total of nine risk factors were also assessed for any potential association with time to clinical stability, length of stay (LOS), and mortality. Results During the 2-year study, from a Louisville population of 102 264 adults aged 65 years or older, 4760 were hospitalized with CAP. The incidence of older adults hospitalized with CAP was 2093 per 100 000 population. This corresponds to 967 470 older adults in the United States hospitalized per year with CAP. The median time to clinical stability was 2 days, and the median LOS was 6 days. The 30-day all-cause mortality was 17%. The 1-year all-cause mortality was 38% (829 patients), which corresponds to 361 982 deaths in the United States with CAP in older adults. Conclusion The estimated burden of CAP in older adults is substantial in the United States. Nearly 1 million older adults are hospitalized for CAP, and over a third of those die within 1 year. J Am Geriatr Soc 68:1007-1014, 2020.

INTRODUCTION Papillary thyroid carcinoma (PTC) is the most common form of well-differentiated thyroid carcinoma. Despite its well-differentiated microscopic features, PTC may be minimally or overtly invasive. We present the case of a patient in whom thoracic spinal cord compression was the first presentation of metastatic PTC. CASE REPORT A 65-year-old woman presented with deteriorating mobility over a 2-month period. Her past history was significant for a right hemithyroidectomy 10 years prior. Examination revealed bilateral lower limb weakness, worse on the right side. Investigations showed a large extradural contrast-enhancing mass at the T7 spinal level. Laminectomy and debulking of this lesion was undertaken. Histopathological examination revealed PTC. The patient proceeded to further treatment with external beam radiotherapy. DISCUSSION Spinal metastases are an unusual presentation of PTC. Further research into the outcomes for these patients is imperative to bettering our ability to care for these patients through a multi-modality approach. .

Gender differences persist in the social work academy. We follow up and extend the work of Sakamoto, Anastas, McPhail, and Colarossi. A multistage probability sample of Council on Social Work Education (CSWE)-accredited programs yielded a 21% response rate ( n = 535) by faculty to an electronic survey. A significant difference was found on base salary with men earning $76,337 and women earning $70,400. On many status variables, women and men have achieved parity; but, men are significantly more likely to be full professors. Gender differences were found on all seven climate subscales. CSWE must obtain robust data, at the individual level, on salary and other implicit curricular items.

Background and ObjectivesIn evaluating integrated care models, traditional quality measures do not account for functional and quality of life factors, affecting older adults with multiple chronic conditions. The objective of this study was the development and validation of the Flourish Index (FI), an instrument to evaluate integrated care, using a determinants of health model.Research Design and MethodsThe study took place within the evaluation study of the Flourish Model (FM). The FM provides care coordination services using an integrated primary care and community-based services model. Baseline data from 70 older adults were used in the validation study. Twenty-seven quality of care indicators within six determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social, formed part of the FI.ResultsCategorical principal components analysis showed a 5-dimensional structure with psychological determinants loading on the biological determinants of health. Internal consistency (Cronbach’s alpha) for the determinants was as follows: biological/psychological = 0.73, individual = 0.58, environmental = 0.62, health services = 0.65, social = 0.67, total score = 0.97. Sensitivity to change was shown for the total FI score (F1,22 = 8.82, p = .01) and social (F1,22 = 5.82, p = .02), with a trend toward sensitivity for individual health behaviors (F1,22 = 3.95, p = .06) and health services (F1,22 = 3.26, p = .09).Discussion and ImplicationsThe preliminary analysis of the FI shows promise for the usability of the index to provide insight into the fundamental challenges of aging. It brings greater clarity in caring for older adults and supports quality evaluation of integrated care coordination models.

Our global population is aging at an accelerated pace. While the average life expectancy has seen dramatic increases, chronic disease and disability have also increased, with rural America tending to be older, sicker, and poorer. This article examines the implementation and outcomes associated with the community engagement method of the world café that was instrumental in developing a “culture of health” aimed to reduce diabetes-related inequalities for older adults in rural counties of Kentucky. Older residents and the organizations that serve them participated in world cafés, which resulted in collective action due to the wisdom and capacity that evolve from the core element of the method, conversational sharing via multiple small group interactions. Four world cafés were held to explore the desires of the communities related to healthy eating, exercise, smoking cessation, and diabetes care. The world cafés brought a diverse group of community residents and governmental and business leaders to discuss topics that matter to their community, leading to the development of a strategic plan and a scorecard and, ultimately, community empowerment.

BACKGROUND Cancer-related sexual dysfunction has been reported among adolescents and young adults (AYAs); however, its prevalence over time has not been examined. This longitudinal study investigated sexual dysfunction in AYAs over the course of 2 years after the initial diagnosis. METHODS Young adult patients (18-39 years old) completed the Medical Outcomes Study Sexual Functioning Scale within the first 4 months of their diagnosis (n = 123) and again 6 (n = 107) and 24 months later (n = 95). An ordered multinomial response model analyzed changes in the probability of reporting sexual dysfunction over time and the independent effects of demographic, clinical, and psychosocial variables. RESULTS More than half of the participants reported sexual functioning to be problematic at each assessment. The probability of reporting sexual dysfunction increased over time (P < .01) and was greater for cancer patients who were female (P < .001), older (P < .01), married or in a committed relationship (P < .001), treated with chemotherapy (P < .05), and reporting comorbid psychological distress (P < .001) and lower social support (P < .05). For women, being in a relationship increased the likelihood of reporting sexual problems over time; for men, the likelihood of reporting sexual problems increased regardless of their relationship status. CONCLUSIONS A substantial proportion of young adults report ongoing problems with sexual functioning in the first 2 years after their cancer diagnosis. These findings justify the need to evaluate and monitor sexual functioning throughout a continuum of care. Cancer 2018;124:398-405. © 2017 American Cancer Society.

Extracting the maximum possible information from the available measurements is a challenging task but is required when sensing seismic signals in inaccessible locations. Compressive sensing (CS) is a framework that allows reconstruction of sparse signals from fewer measurements than conventional sampling rates. In seismic CS, the use of sparse transforms has some success; however, defining fixed basis functions is not trivial given the plethora of possibilities. Furthermore, the assumption that every instance of a seismic signal is sparse in any acquisition domain under the same transformation is limiting. We use beta process factor analysis (BPFA) to learn sparse transforms for seismic signals in the time slice and shot record domains from available data, and we use them as dictionaries for CS and denoising. Algorithms that use predefined basis functions are compared against BPFA, with BPFA obtaining state-of-the-art reconstructions, illustrating the importance of decomposing seismic signals into learned features.

This study examines the development of an interprofessional training certificate program that prepares social work learners to infuse geriatrics and behavioral health into primary care settings. Since 2018, our program has trained 31 social work learners and 16 learners from counseling psychology and nursing. At the core of the certificate program is an emphasis on developing skills focused on the integration of geriatrics, behavioral health and primary care to address the lack of workforce trained at the intersection of these areas. Each series of workshop is aligned with core competencies that address the 4-M Model of Age-Friendly Health Care and SAMSHA’s Core Competencies in Behavioral Health. Our professional certificate includes training in Motivational interviewing, as well as Cognitive behavioral therapy, Mindfulness based cognitive therapy and Problem-solving therapy, Narrative Therapy, Strategic Therapy, Systemic Therapy, Life Review and Reminiscence Therapy. Additionally, students receive professionalization trainings to help prepare them for the job market. To measure the efficacy of this curriculum program, we examined the outcomes related to student knowledge of geriatrics and behavioral health including knowledge attainment, fidelity to modalities, learner self-efficacy, and learner satisfaction. The results of this study showed that integrating interprofessional education into social work settings can lead to positive outcomes for student knowledge, self-efficacy and learning satisfaction. Additionally, we found that having a curriculum that focused on interprofessional teams contributed to higher self-efficacy in completing tasks compared to previous cohorts. This has implications for the way that we conceptualization the use of interprofessional education.

Patients with metastatic disease are routinely serially imaged to assess disease burden and response to systemic and local therapies, which places ever-expanding demands on our healthcare resources. Image interpretation following stereotactic body radiotherapy (SBRT) for spine metastases can be challenging; however, appropriate and accurate assessment is critical to ensure patients are managed correctly and resources are optimised. Here, we take a critical review of the merits and pitfalls of various imaging modalities, current response assessment guidelines, and explore novel imaging approaches and the potential for radiomics to add value in imaging assessment.

In this paper, we present a graph-based semi-supervised framework for hyperspectral image classification. We first introduce a novel superpixel algorithm based on the spectral covariance matrix representation of pixels to provide a better representation of our data. We then construct a superpixel graph, based on carefully considered feature vectors, before performing classification. We demonstrate, through a set of experimental results using two benchmarking datasets, that our approach outperforms three state-of-the-art classification frameworks, especially when an extremely small amount of labelled data is used., Comment: Four pages with two figures

Background The incidence of Glioblastoma Multiforme (GBM) is increasing among the older population and is associated with poor prognosis. Management guidelines are lacking in this group. The purpose of this study was to analyze survival data and determine predictors of survival in patients aged ≥70 years treated with radiotherapy (RT) and/or Temozolomide. Materials and Methods A retrospective analysis of all GBM patients treated at our institution between January 2011 and January 2017 was carried out. Results One‐hundred and four patients were eligible. Median age was 73.8 years (70‐87). Thirty‐three patients received radical RT and 71 palliative RT. Overall median survival (MS) was 6 months. The MS was 10.6 months for radical patients and 4.9 months for palliative patients (P

Obstructive sleep apnea (OSA) may have prothrombotic effects. To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE). In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy. Obstructive sleep apnea patients with an apnea–hypopnea index (AHI) ≥ 15/h cohort were significantly older (p

Data from the Health and Retirement Study were used to test a conceptual model integrating stress and coping, conservation of resources, and life-course theories, to investigate predictors of depression symptoms over 8 years among a nationally representative sample of older adults aged 50-91 years. The main investigative questions were: (1) Do older adults with cancer have a different 8-year symptomatic depression trajectory than those without cancer? (2) Do the differences in life-course factors, internal, external, and health-related resources within and between older adults have a differential effect on 8-year symptomatic depression trajectories for individuals with and without a cancer diagnosis?We used a two-level longitudinal panel design to test a multilevel growth model. We examined individual differences in depression symptoms between 2000 and 2008, and tested multiple potential predictors. All those with a first diagnosis of cancer in 1998-2000 were included in the study (n = 200) together with a representative subsample of all noncancer cases (n = 1,190).Significant two-way interaction effects were detected between having cancer and the absence of spouse/partner in the home, and cancer and lower life expectancy; each resulted in higher probabilities of depression. A significant three-way interaction effect was detected between cancer, gender, and social support; women with a cancer history and low social support had the highest probability of depression.Assessment and intervention in the "survivorship" phase of cancer should target older adults with higher levels of depression early in the cancer experience, those with no partner present in home, those with lower life expectancy, and women with low social support.

The use of stereotactic radiosurgery to treat multiple intracranial metastases, frequently concurrently, has become increasingly common. The ability to accurately and safely deliver stereotactic radiosurgery treatment to multiple intracranial metastases (MIM) relies heavily on the technology available for targeting, planning, and delivering the dose. A number of platforms are currently marketed for such applications, each with intrinsic capabilities and limitations. These can be broadly categorised as cobalt-based, linac-based, and robotic. This review describes the most common representative technologies for each type along with their advantages and current limitations as they pertain to the treatment of multiple intracranial metastases. Each technology was used to plan five clinical cases selected to represent the clinical breadth of multiple metastases cases. The reviewers discuss the different strengths and limitations attributed to each technology in the case of MIM as well as the impact of disease-specific characteristics (such as total number of intracranial metastases, their size and relative proximity) on plan and treatment quality.

The University of Louisville GWEP has partnered with Mountain Comprehensive Care, a FQHC with 9 practices in 5 rural counties in KY, to infuse the 4 M’s of age-friendly health care systems into their daily practices, namely what matters most, medication management, mentation and mobility. Many lessons were learned during this infusion period, specifically related to cultural and rural barriers that make some of these principles very difficult to implement. Specifically, what matters most to older adults in these very poor rural areas may not be the safest way to proceed; medication management may be difficult to do due to the extent of opioid addictions in these areas, mentation has many challenges related to isolation and lack of understanding of dementia and mobility issues are complicated due to the many home barriers to fall safety environments. These lessons will be discussed in this part of the symposium presentation.

Federally Qualified Health Centers (FQHC) are important safety net providers in disadvantaged communities. As outpatient clinics in these areas, they qualify for specific reimbursement systems under Medicare and Medicaid. Age-friendly health care is an urgent need to be able to provide quality healthcare to more than 46 million Americans age 65 and older, with that number projected to double to more than 98 million by 2060. Friendly healthcare systems require a focus on the 4Ms framework and is focused on improving the health of people at every life stage and in every community across the country. The 4Ms are as follows: 1) What Matters: Aligning care with each older adult’s specific health outcome goals and care preferences; 2) Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility; 3) Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care and 4) Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters. An age-friendly health system is one in which every older adult’s care is guided by these evidence-based practices (the 4Ms), where the care causes no harms, and where the care is consistent with what matters to older adults and their families. In this symposium five Geriatric Workforce Enhancement Programs at five diverse universities will share their experiences with supporting FQHC in their areas to become age-friendly healthcare systems. The unique lessons learned at these different sites will be shared.

Serving older adults with multiple chronic conditions and variable social, emotional, or physical support effectively within the primary care setting requires an interdisciplinary approach to care, together with the integration of novel approaches to care coordination (Dorr et al, 2006). The purpose of this study is to examine the use of interprofessional learning models to educate a healthcare workforce that meets the needs of older adults by integrating geriatrics with primary care, maximizing patient engagement, and transforming the healthcare system. Specifically, the targeted learners for this curriculum were from a healthcare system in Belize that had no previous specialty training in interprofessional geriatrics care. The 4-day training took place in Belize with an interprofessional group of healthcare professionals that included social work, nursing and medicine. 100 learners participated in the trainings and including participants from social work, nursing and medicine. To evaluate the program, Kirkpatrick’s Training Evaluation Model (Kirkpatrick & Kirkpatrick, 2005) was used to determine if learners were satisfied with the content (reaction), skilled (knowledge & skill) and confident in their abilities to utilize the curriculum (application of knowledge & skills). Analysis showed that learners, irrespective of discipline, were satisfied with the program. All disciplines experienced significant differences in their self-efficacy with working on interdisciplinary teams from pre to post assessments. Specifically, there was an increase in learner’s confidence related to learning to work together cooperatively with other professions and how to communicate effectively with other members of an interprofessional team. Implications for future interprofessional curriculum will be discussed.

Despite the current pressure to reduce state and federal spending, policymakers must find ways to address the challenges of a growing population of older adults with complex health care problems. There is an increased need for the health professions workforce to have collaborative care skills and geriatric clinical competencies. Therefore, programs like the Geriatric Workforce Enhancement Program (GWEP) and the Geriatric Academic Career Awards (GACA) are important in strengthening the workforce and supporting policy development that addresses increased demands on the health care system. In 2019, the Bureau of Health Professions, under the Health Resources and Services Administration, provided 48 GWEP awards and 26 GACA awards in 37 states and 2 territories. These programs play an important advocacy role to improve on and expand geriatric education. This symposium provides an overview of these programs and their role in advancing geriatric care and in shaping policy.