Marjorie A. Getz

Nutritional Risk and Body Composition in Free-Living Elderly Participating in Congregate Meal-Site Programs

Abstract Early detection of nutritional risk in free-living elderly is critical in healthcare, yet comprehensive measurements are time consuming and can be frustrating to both health professionals and elderly. In addition, body composition measurements provide information regarding fat and fatfree mass that have been linked to morbidity and mortality in elderly. In this study, nutritional risk was assessed in 69 elderly, aged 50-90 years, attending congregate mealsite programs, using Mini Nutritional Assessment, and body composition was assessed by bioelectric impedance. Analysis revealed that 31.9% of the elderly were at risk for malnutrition and 2.9% were malnourished. Males had significantly greater body weight, height and fatfree mass, and females had significantly greater body fat as percentage of body weight, but there was no gender difference in nutritional risk. Of elderly, 36.2% had body mass index > 85th percentile and 8.7% < 15th percentile using national population reference standards. Age-related decline in fatfree mass was an early indicator of changes in body composition.

Evaluation of a standardized all-terrain vehicle safety education intervention for youth in rural Central Illinois.

Background: Although research investigating all-terrain vehicle (ATV) riders and ATV injury patterns has led to support for legislative and educational efforts to decrease injuries in users younger than 16 years, there is little published data regarding the utility of ATV safety education programs. This study investigates the effectiveness of a standardized adolescent ATV safety program in changing the safety knowledge and safe ATV riding practices reported by rural Central Illinois youths. Methods: A convenience sample of 260 rural Central Illinois middle and high school students received an ATV safety presentation with both didactic and interactive features during the 2009-2010 school year. Preintervention and postintervention surveys were distributed and collected by teachers. Survey questions consisted of multiple-choice questions pertaining to demographics, ATV safety knowledge, and ATV riding practices. More than 200 surveys were collected prior to the intervention and 165 surveys were collected 12 to 24 weeks after the intervention. Percentages are reported, with differences in nominal variables tested by χ2 test and interval variables by t test. Results: Following the intervention, there was a significant increase in the correct response rate for ATV safety knowledge questions (45.2% vs 56.2%, P < .001). For adolescents who reported riding ATVs, both safety gear use (11.8% to 21.2%, P = .05) and helmet use (25.4% to 29.0%, P = .56) increased; changes were not significant. Adolescent ATV riders reporting 2 or more accidents showed a slight nonsignificant decrease (25.2% vs 23.4%, P = .77) between the time of the pretest and posttest. Conclusion: This safety program was effective at increasing ATV safety knowledge but demonstrates limited effect on safe riding practices.

Evaluation of a Novel Animal Model for Teaching Intubation

Background: Medical colleges, which face dwindling financial resources, are often forced to rely on inexpensive means of providing students with relevant learning opportunities. Purposes: In this article, we present an evaluation of a novel animal model to be used to teach medical students, resident physicians, and allied health personnel advanced airway management skills, namely, endotracheal intubation. Methods: Over 3 years of regularly scheduled teaching laboratories, 140 students had exposure to both a traditional teaching manikin and a whitetail deer head on which to learn rescue airway techniques. We measured participants on successfully completing an intubation, and we timed them to determine length of time to complete it. Participants also rated the experience across a variety of dimensions. Results: Students reported being very satisfied with the learning experience and were able to perform the techniques more quickly and accurately using the animal model. Conclusions: The deer airway model is superior to the manikin airway model in teaching endotracheal intubation to students. It should be considered as a viable alternative in medical education settings.

Use of a novel animal prototype to teach advanced airway management skills.

Background: Airway management skills are a vital part of emergency medicine training. Mastery of these skills requires didactic, model, and real-patient experiences. Practice with the use of relevant models greatly enhances these skills. Description: This study evaluated the effectiveness of deer heads as a novel, low-cost animal model for teaching 7 separate intubation procedures. Evaluation: One hundred and forty people at various levels of clinical training learned from 1 to 7 intubation techniques and practiced on the animal model. Each procedure was rated using a 5-point scale (excellent-poor) on the quality of instruction associated with teaching the procedure and perceived usefulness of the model when compared with human patients. Conclusion: Combined results across all procedures showed that 94.8% believed the deer head models to be excellent, very good, or good models for demonstrating the techniques (range of favorable responses across all techniques was 87.5% to 98.8%). Deer heads serve as good to excellent aids for practicing advanced airway management skills. They are readily available and free of cost. This model should be considered in airway skills training.

Nutrition Screening and Assessment by Anthropometry and Bioelectrical Impedance in the Frail Elderly

Abstract Nutrition screening is recommended to identify those at risk for malnutrition; nutrition assessment by anthropometry and impedance is widely used to indicate nutritional status but may be problematical in the frail elderly in nursing homes. Acceptability, availability, suitability and appropriate reference data influence clinical application of these measurements. In our study, nutrition screening and assessment methodology were evaluated in 46 nursing home residents, mean age 86.3 ± 6.6 years, mean weight 66.1 ± 12.9 kg, mean height 163.1 ± 9.6 cm, and mean BMI 24.9 ± 4.6 kg/m2. Significant correlations (P < 0.05) were found in all measures of body weight, BMI, body fatness and leanness. Interpretation of data by five different reference standards and cutoff points revealed wide variation in identification of malnutrition by anthropometry. Appropriate reference data for body lean and fatness are not yet available. Thus, populationspecific methodology and reference standards are of crucial importance.

All-terrain vehicle dealership point-of-sale child safety compliance in Illinois.

Objectives In 2008, an estimated 37,700 children younger than 16 were treated in US emergency departments for nonfatal all-terrain vehicle (ATV) injuries. This study identifies safety guidelines and recommendations dealers convey to consumers at the point of sale. Methods A telephone survey of all 2004 licensed motorcycle dealers in Illinois was conducted. Trained investigators, using aliases and posing as a parent of a 13-year-old teenager, spoke with dealership personnel. Investigators indicated they wished to purchase an ATV with the dealership, but had no knowledge of ATV use or safety issues. The telephone call’s true purpose was concealed during the survey. Specific responses from the salesperson, models and brands of ATVs, price quotes, engine sizes, and safety information/recommendations were recorded in a written survey instrument. Results One hundred twenty-seven ATV dealers completed the survey. A salesperson most often fielded the telephone interview (124/127). Telephone interviews by male investigators were longer than those by female interviewers (5 minutes 37 seconds vs 3 minutes 51 seconds; P = 0.001). Dealers recommended Consumer Product Safety Commission–based child-size ATVs (<90 mL engine size) during 75% of the calls. Nearly all dealers recommended helmet use (108/127), and few (3/127) labeled the vehicles as “safe.” Most dealers (83.5%) recommended some form of rider training, with half (49.6%) offered point-of-purchase training. Conclusions All-terrain vehicle dealers in Illinois recommend child-size vehicles, safety training, and helmet use for the majority of telephone inquiries. Injury prevention efforts targeting ATV dealers may be less needed than those using other populations.

Core Practical Objectives: A Means to Standardize the 4th-Year Emergency Medicine Clerkship

Background: Core Practical Objectives (CPOs) are clinical emergency medicine (EM) experiences (including suggested number of patient encounters) that students use to self-direct clerkship progress. Purpose: This study investigates feasibility of implementing EM clerkship CPOs, describes characteristics of students fulfilling CPO guidelines, and relates CPO completion to outcome measures (exam scores and grades). Methods: Cross-sectional research was conducted comparing students completing and not completing CPOs by gender, month of rotation, total patients evaluated, clerkship exam score, and final grade. Results: Over 4 years, 117 students completed an EM clerkship utilizing CPO guidelines. Gender and clerkship month were not associated with fulfilling CPOs. Total CPOs completed correlated positively with percent score on written exam and grade for rotation. Completion of specific CPOs was associated with exam scores and final grade. Conclusions: CPOs were successfully integrated into an EM clerkship. Preliminary data suggest that CPO guidelines can be used to standardize EM clerkships.

Self-Reported Height, Calculated Height, and Derived Body Mass Index in Assessment of Older Adults

Body mass index (BMI) is frequently used as assessment of nutritional and health risk. Yet, there is no consensus regarding assessment of height and cutpoints for weight classification in older adults. We first investigated differences in height by self-report (SR-height) and height calculated from measured knee-height (KH-height) and derived BMI in a cross-sectional assessment of 145 older adults residing in a Midwestern United States city. We further compared the proportion of older adults classified as at risk by seven different BMI cutpoints for weight classification as reported in the literature. We found no substantive difference in SR-height and KH-height or derived BMI, but we did find significant differences in the proportions of participants classified as At Risk across different BMI cutpoints. In community and clinical practice, SR-height and KH-height, and BMI derived from these, can be used interchangeably, but the lack of consensus regarding BMI cutpoints could lead to misclassification of older adults at risk.