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A growing number of frail older adults are treated in the emergency department (ED) and discharged home. There is an unmet need to identify older adults that are predisposed to functional decline and repeat ED visits so as to target them with proactive interventions.
A prospective cohort study was conducted in patients 75 years or older who were being discharged from the ED. The objective was to test the value of frailty screening tests, namely 5-meter gait speed and handgrip strength, to predict repeat ED visits at 1 and 6 months and functional decline at 1 month using multivariable logistic regression.
After excluding 7 patients lost to follow-up, 150 patients were available for analysis. The mean age was 81.1 ± 4.9 years with 51% females, 13% arriving by ambulance, and 67% having at least two comorbid conditions. At ED discharge, 41% of patients were found to have slow gait speed, whereas 23% had weak handgrip strength. After adjustment, only slow gait speed was independently associated with functional decline at 1 month (odds ratio [OR] 1.39 per 0.1 meters/second decrement, 95% confidence interval [CI], 1.12 to 1.72) and repeat ED visits at 6 months (OR 1.20 per 0.1 meters/second decrement, 95% CI, 1.01 to 1.42).
Gait speed can be feasibly measured at the time of ED discharge to identify frail older adults at risk for early functional decline and subsequent return to the ED. Conversely, grip strength was not found to be associated with functional decline or ED visits.
Low serotonin transmission is thought to increase susceptibility to a wide range of substance use disorders and impulsive traits.
To investigate the effects of lowered serotonin on cocaine-induced (1.0 mg/kg cocaine, self-administered intranasally) dopamine responses and drug craving.
In non-dependent cocaine users, serotonin transmission was reduced using the acute tryptophan depletion method. Striatal dopamine responses were measured using positron emission tomography with [11C]raclopride.
Acute tryptophan depletion increased drug craving and striatal dopamine responses to cocaine. These acute tryptophan depletion-induced increases did not occur in the absence of cocaine.
The results suggest that low serotonin transmission can increase dopaminergic and appetitive responses to cocaine. These findings might identify a mechanism by which individuals with low serotonin are at elevated risk for both substance use disorders and comorbid conditions.
The ability to teach is a critical component of residency and future practice. This is recognized by the Royal College of Physicians and Surgeons of Canada, which incorporates teaching functions into the CanMEDS competencies. The aim of our study was to identify how emergency medicine specialty programs across Canada prepare their residents for roles as teachers and to compare these results to those of other Royal College specialty programs.
A 40-item English questionnaire was developed and translated into French. It was e-mailed to the program directors of all Royal College Emergency Medicine (EM), Anesthesia, Diagnostic Radiology, General Surgery, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Psychiatry residency programs. The survey asked what modalities were in use to teach residents how to teach and allowed respondents to comment on recent changes.
Twelve of 13 (92%) EM programs and 78 of 113 (69%) other specialty programs responded. All responding programs incorporated some kind ofmandatory teaching responsibilities. Four of 12 (33%) EM programs reserved formal teaching functions for postgraduate year 3 and above, whereas only 7 of 78 (9%) other specialty programsdid so. The remaining 71 of 78 (91%) non-EM specialty programs incorporated formal teaching functions in all years of residency. Six of 12 (50%) EM programs offered rotations in clinical medical education compared to only 11 of 78 (14%) other specialty programs.
Canadian EM programs appear to differ from other specialty programs in the way that they develop residents-as-teachers. Half of EM programs offer rotations in clinical medical education, and many introduce formal teaching functions later in residency.
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