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In order to improve airport safety management system (SMS) performance, an evaluation system is required to improve on current shortcomings and maximize safety. This study suggests the integration of the DEMATEL and ANP methods in decision making processes by analyzing causal relations between the relevant criteria and taking effective analysis-based decision. The DEMATEL method builds on the ANP method in identifying the interdependencies between criteria. The input data consists of questionnaire data obtained online and then stored in an online database. Furthermore, the questionnaire data is processed using DEMATEL and ANP methods to obtain the results of determining the relationship between criteria and criteria that need to be evaluated. The study cases on this evaluation system were Adi Sutjipto International Airport, Yogyakarta (JOG); Ahmad Yani International Airport, Semarang (SRG); and Adi Sumarmo International Airport, Surakarta (SOC). The integration grades SMS performance criterion weights in a descending order as follow: safety and destination policy, safety risk management, healthcare, and safety awareness. Sturges' formula classified the results into nine grades. JOG and SMG airports were in grade 8, while SOG airport was in grade 7.

Quality improvement (QI) is part of the future of medicine. However, QI concepts are often poorly understood by physicians. Although teaching QI is required in resident training, an effective QI curriculum is difficult to design due to competing demands from clinic schedules and required rotations. The objective of this project was to teach family medicine residents the basic concepts of QI and practical implementation skills based on use of a clinic population, electronic medical record (EMR) system, and Plan-Do-Study-Act (PDSA) cycles. To do this, the Family Medicine residents and faculty at the University of Hawai`i participated in a QI curriculum to improve diabetes care from October 2018 to February 2019 with 5 sessions consisting of lectures, videos, discussions about QI data for diabetes patients, and group activities. Residents and faculty used quality measures pulled from the EMR and PDSA cycles to discuss, select, and implement QI projects for diabetes patients. Pre- and post-tests measured participants' baseline and end QI knowledge and skills. All 18 residents and 12 faculty in the program participated in the curriculum. The pre- and post-test comparisons showed significant improvement in knowledge of QI concepts and the comfort level among residents showing a 59% average improvement in knowledge questions and a 57% average improvement in comfort level in implementing a QI project (Table 4). This study shows that a 5-session QI curriculum based on EMR and PDSA cycles successfully increased family medicine residents' and faculty's knowledge of QI concepts and skills., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Objectives: To evaluate the changes in types of medications prescribed for pain before and after withdrawal of certain selective cyclooxygenase 2 (COX-2) inhibitors in 2004 and to determine whether there was an association with fall events in elderly adults with a diagnosis of osteoarthritis (OA)., Design: A nested case-control design using electronic medical records compiled between 2001 and 2009., Setting: Electronic medical records for care provided in an integrated health system in rural Pennsylvania over a 9-year period (2001-09), the midpoint of which rofecoxib and valdecoxib were pulled from the market., Participants: Thirteen thousand three hundred fifty-four individuals aged 65 to 89 with a diagnosis of OA., Measurements: The incidence of falls and fractures was examined in relation to analgesics prescribed: narcotics, COX-2 inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). The comparison sample of individuals who did not fall was matched 3:1 with those who fell according to age, sex, and comorbidity., Results: Narcotic analgesic prescriptions were associated with a significantly greater risk of falls and fractures. The likelihood of experiencing a fall/fracture was higher in participants prescribed narcotic analgesics than those prescribed a COX-2 inhibitor (odds ratio (OR) = 3.3, 95% confidence interval (CI) = 2.5-4.3) or NSAID (OR = 4.1, 95% CI = 3.7-4.5)., Conclusion: Use of narcotic analgesics is associated with risk of falls and fractures in elderly adults with OA, an observation that suggests that the current guidelines for the treatment of pain, which include first-line prescription of narcotics, should be reevaluated., (© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.)

It has previously been shown that medical students perform poorly when assessing older adults with recurrent falls. To address this and teach students about other geriatric syndromes, a standardized patient, played by one of nine actresses, aging during the course of an afternoon, was developed. The patient is first aged 75 with falls, then 80 with memory problems, then 82 with an acute confusional state. The third-year students interact with the patient on a one-to-one basis. After seeing and examining her, the students write up the case and then meet with the supervising physician after each section to discuss the case. This intervention was well accepted, scoring 5.95 on a 7-point Likert-type scale. At the end of the clinical year, the students participated in an eight-case clinical skills examination that included a 79-year-old man with falls. Using the actor's checklists, the performances of the 42 medical students who had participated in the standardized patient experience were compared with those of the 128 who had not. Over the eight cases, there was no difference in the three domains of communication, information gathering, and physical examination, but in the geriatric case, the students who had participated in the experience performed significantly better in all three domains. The intervention students were also three times as likely to examine the subject's gait (60% vs 20%). A 3-hour interactive session substantially improved specific geriatric competencies. One can only wonder what more dedicated time could accomplish., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Objectives: To determine the influence of homocysteine on mobility decline in older adults., Design: Prospective cohort., Setting: Einstein Aging Study, community-based aging study., Participants: Five hundred seventy-four older adults without dementia (mean age 80.2 +/- 5.4, 61% women)., Measurements: Mobility decline defined using gait velocity measurements at baseline and annual follow-up visits. Linear mixed effects models were used to adjust for age, sex, education, and other potential confounders., Results: Higher homocysteine levels were associated with slower gait velocity at baseline. Adjusted for age, sex, and education, a one-unit increase in baseline log homocysteine levels was associated with a 2.95-cm/s faster mobility decline per year (P=.01) over a median follow-up of 1.4 years. The 140 subjects in the highest quartile of homocysteine had a faster rate of mobility decline (1.75 cm/s per year faster, P=.01) than the 434 subjects in the lowest three quartiles of homocysteine (

As part of the development of a curriculum for medical students and rehabilitation residents at New York University School of Medicine, an Objective Structured Clinical Examination (OSCE) station was developed for formative evaluation. The goal was to determine the existing knowledge and competence of medical students and rehabilitation residents in the analysis and treatment of a geriatric patient with a history of falls. This OSCE station was designed to focus on three specific clinical skills needed in assessing the elderly faller. The OSCE station was a standardized patient (SP) encounter with a 75-year-old man presenting with falls. Seventy-five medical students and 41 rehabilitation medicine residents participated in the study. There was high agreement between the SP and a geriatric physician used to assess performance on gait (Cronbach alpha=0.918) and orthostatic blood pressure (Cronbach alpha=0.887) assessment. Of the medical students, 43.5% did not check orthostatic blood pressure, 56.8% did not evaluate gait, and 92.0% did not consider assistive device prescription. Only 20.0% checked both orthostatic blood pressure and gait. Likewise, 73.8% of residents did not check orthostatic blood pressure, 38.1% did not evaluate gait and 92.9% did not consider assistive device prescription. Only 19.0% checked both orthostatic blood pressure and gait. The results of this examination are alarming and suggest that education regarding the approach to an elderly person who falls is inadequate, leaving students and residents poorly prepared to take care of the "silver tsunami."

Use of over-the-counter (OTC) medications is becoming more of a problem in the older adult population as the push to deregulate prescription medications grows. This article summarizes the side effects, adverse reactions, and medication interactions older adults face when using some common OTC medications.