Christopher Frank

Deprescribing for older patients

The principles that guide optimal prescribing for older patients[1][1],[2][2] ([Box 1][3]) include deprescribing medications that are no longer indicated, appropriate or aligned with evolving goals of care. Deprescribing is a relatively new term that focuses attention on the sometimes overlooked

Deprescribing: a new word to guide medication review

See related cases by Farrell and colleagues at [www.cmaj.ca/lookup/doi/10.1503/cmaj.122012][1] (Oct. 1 issue) and [www.cmaj.ca/lookup/doi/10.1503/cmaj.130523][2] (page [445][3], this issue) A literature search on optimizing medications will yield a number of peer-reviewed articles containing the

Physician sex is a predictor of reporting drivers with mild cognitive impairment and mild dementia to transportation authorities

1. Gaskell H, Derry S, Andrew Moore R et al. Prevalence of anaemia in older persons: Systematic review. BMC Geriatr 2008;8:1. 2. Balducci L, Ershler WB, Bennett JM, eds. Anemia in the Elderly. New York: Springer Science + Business Media, LLC, 2007. 3. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012; 19:133–140. 4. Causey MW, Miller S, Foster A et al. Validation of noninvasive hemoglobin measurements using the Masimo Radical-7 SpHb Station. Am J Surg 2011;201:592–598. 5. Gayat E, Aulagnier J, Matthieu E et al. Non-invasive measurement of hemoglobin: Assessment of two different point-of-care technologies. PLoS ONE 2012;7:e30065. 6. Butwick A, Hilton G, Carvalho B. Non-invasive haemoglobin measurement in patients undergoing elective Caesarean section. Br J Anaesth 2012;108:271–277. 7. de Benoist B, McLean E, Egli I et al., eds. Worldwide Prevalence of Anaemia 1993–2005. Geneva, Switzerland: World Health Organization, 2008. 8. Hahn RG, Li Y, Zdolsek J. Non-invasive monitoring of blood haemoglobin for analysis of fluid volume kinetics. Acta Anaesthesiol Scand 2010; 54:1233–1240. 9. Macknet MR, Allard M, Applegate RL 2nd et al. The accuracy of noninvasive and continuous total hemoglobin measurement by pulse CO-oximetry in human subjects undergoing hemodilution. Anesth Analg 2010;111: 1424–1426.

Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators

BACKGROUND Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators. METHODS A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patients clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver. CONCLUSIONS An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Humanities and Geriatric Education: a Strategy for Recruitment?

Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees’ attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching.

Time to consensus: the effect of the stomach on consensus decision-making at large conferences

Introduction: The factors affecting decision-making at consensus conferences are not well understood. This paper studies the complex association between time to consensus (TTC) and the timing and quality of food, as well as the self-reported level of frustration (PITA factor) with the question at hand. Methods: We came, we saw, we ate. Results: There was an association between the TTC and the time to eating, especially lunch. There was a trend to faster TTC the better the researchers rated the food. The speed of decision-making was also increased when the PITA score was high, especially late in the day. Interpretation: Organizers of large consensus conferences need to be aware of these factors in decision-making and should try to use them to get more controversial items voted to their satisfaction.

#CGS2015: An Evaluation of Twitter Use at the Canadian Geriatrics Society Annual Scientific Meeting.

Background Twitter is a microblogging platform increasingly used in medicine to overcome geographic barriers and promote international connections. Tweets, the 280-character microblogs, are catalogued by hashtags (#). This study evaluates and describes the participation, content, and impact of Twitter at the 2015 Canadian Geriatrics Society (CGS) Annual Scientific Meeting, during which #CGS2015 was the official conference hashtag. Methods Twitter transcripts of #CGS2015 were obtained from Symplur to prospectively analyze tweets for content and quantitative metrics. TweetReach was used to retrospectively analyze tweets with the hashtag #CGS2014 from the 2014 meeting for growth analysis. The impact of Twitter on the conference experience was derived from questionnaires. Results There were 1,491 #CGS2015 tweets, 40% of which were original. Tweet content was categorized into conference sessions (38.8%), networking (29.2%), resource sharing (17.6%), and conference promotion (14.3%). Of the 279 participants, 60% were non-Canadian. The questionnaire data from 86 respondents demonstrated generally positive experiences with Twitter, particularly with facilitating collegial interactions, resource sharing, and insight into sessions not attended live. The most cited drawback was divided attention when using personal devices. Analysis comparing #CGS2014 to #CGS2015 demonstrated increases in total participants (50 to 279), number of tweets (434 to 1,491) and impressions (155,600 to 943,825). Conclusions Twitter engagement at the CGS 2015 annual meeting enabled international participation in networking, resource sharing, and online discussions of sessions. Future conferences may benefit from a workshop on Twitter basics for attendees and presenters.

A DRIVING IN DEMENTIA DECISION TOOL: PRELIMINARY ANALYSIS

data source for this study. Leadership of voluntary health organizations change. This study tracks changes in leadership between 2000 and 2015. Analytical methods consist of content analysis and network analysis, which are conducted in an effort to understand how innovation across the field may be changing. Results: This study finds change in missions of voluntary health organizations tends to follow change in leadership in those organizations. Mission change is most significant in two situations: (1) when new leaders have weak ties to the organization and (2) when networks among new leaders are strong.Conclusions:As national voluntary health organizations re-shape themselves, changes in leadership will influence futures of these organizations. Organizations should pay attention to relationships among leaders and their relationships to the voluntary health organizations and the parallels among the missions and approaches of different advocacy groups.

Pre-Clerkship Observerships to Increase Early Exposure to Geriatric Medicine

Background and Purpose To foster interest in geriatric care, the Queen’s Geriatrics Interest Group (QGIG) collaborated with the Division of Geriatric Medicine to arrange a Geriatrics Pre-Clerkship Observership Program. Methods Forty-two pre-clerkship medical students participated in the program between October 2013 and May 2014. Participants were paired with a resident and/or attending physician for a four-hour weekend observership on an inpatient geriatric rehabilitation unit. The program was assessed using: (1) internally developed Likert scales assessing student’s experiences and interest in geriatric medicine before and after the observership; (2) University of California Los Angeles–Geriatric Attitudes Scale (UCLA-GAS); and (3) narrative feedback. Results All participants found the process of setting up the observership easy. Some 72.7% described the observership experience as leading to positive changes in their attitude toward geriatric medicine and 54.5% felt that it stimulated their interest in the specialty. No statistically significant change in UCLA–GAS scores was detected (mean score pre- versus post-observership: 3.5 ± 0.5 versus 3.7 ± 0.4; p=.35). All participants agreed that the program should continue, and 90% stated that they would participate again. Conclusions The observership program was positively received by students. Structured pre-clerkship observerships may be a feasible method for increasing exposure to geriatric medicine.