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P OSTER
A BSTRACTS
TNF-R1 levels were compared across tertiles of IL-6 levels using a
Hodges-Lehmann non-parametric K-sample median test.
Results: The analytic sample included 1429 participants with
available data for both inflammatory markers and all adjusted covariates,
among whom 408 were HIV-infected and 1021 were HIV-uninfected.
In an adjusted model, a one log increase in ln(IL-6) was associated
with a 0.123 (95% confidence interval [CI] =0.102-0.145, p <
.001) log increase in ln(TNF-R1). This association was further
demonstrated by a 0.115 log increase in ln(TNF-R1) for every one
standard deviation change in ln(IL-6) (95% CI =0.095-0.135, p <
.001). Moreover, higher median TNF-R1 levels were observed in the
top tertile of IL-6 levels (1753 versus 1404 pg/ml, p < .001), regardless
of HIV status and changes in CRP.
Conclusions: IL-6 and TNF-R1 levels were positively associated
in the ALIVE study. These findings provide initial insight into the relationship
between IL-6 and TNF-R1 in this unique population and
suggest further investigations into potential mechanisms leading to
generalized inflammation and immune activation in HIV infection
and aging.
A64
Care of the Vulnerable Elder Practice Improvement Module: Chart
Review Alone as a Valuable Educational Experience.
E. Oleson, S. McGee, M. Zanetti, S. Barrett, M. Pugnaire,
J. Gurwitz, C. DuBeau. University of Massachusetts Medical School,
Worcester, MA.
Supported By: Supported by the Donald W. Reynolds Foundation
Background: The Care of the Vulnerable Elder Practice Improvement
Module (COVE-PIM) was developed by the American
Board of Internal Medicine for maintenance of board certification
and has been adapted for residency programs. The COVE-PIM includes
chart review of geriatric care to identify any gap in care, evaluation
of the care system, and a quality improvement (QI) project to
address the gap. We included COVE-PIM into a new required Ambulatory
Care Block rotation for Medicine residents at UMass Memorial
Medical Center as part of the geriatric medicine curriculum. Care
system review and QI projects were not feasible in our setting, therefore,
we adapted COVE-PIM as a formative exercise with chart review
and a reflective evaluation on changes the residents would make
make in the care of their older patients as a result of the exercise.
Methods: Residents were asked to complete chart reviews on
five patients > 60 years in their continuity clinic using the standard
COVE-PIM review of documented chronic medical conditions,
health habits, screening measures, physical exam, and advanced directive
discussions. The reflective evaluation consisted of the resident’s
anticipated changes in care of the elderly in screening for geriatric
syndromes, such as cognitive impairment and falls, and documenting
surrogate decision makers and advanced directives by completing the
COVE-PIM chart review.
Results: A total of 31 PG1 and PG2 Medicine residents completed
112 chart reviews across 9 different clinical sites. Ninety percent
of residents reported that the formative experience was useful
and 100% of the residents felt the exercise increased the likelihood
they would screen for common geriatric conditions. In the chart review,
34% of residents reported documentation of wishes for life-sustaining
care and 39% had recorded surrogate decision makers. In the
reflective evaluation, 90% of residents felt that the exercise would
improve their likelihood of documenting surrogate decision makers
and discussions regarding end-of-life care.
Conclusions: COVE-PIM chart review alone with added reflective
evaluation helped residents identify gaps of care among their
older patients and was considered a valuable educational experience
that residents anticipated would impact future care. This modification
may be more suitable for shorter ambulatory rotations.
A65
Integration of Geriatric Medicine into a Multi-Year Ambulatory
Care Block Curriculum.
E. Oleson, S. McGee, E. Murphy, G. Manchester, C. DuBeau.
University of Massachusetts Medical School, Worcester, MA.
Supported By: Supported by the Donald W. Reynolds Foundation
Background: We describe the successful transition of a PGY1
geriatric medicine block rotation for Medicine residents into an integrated,
multi-year PGY1-3 Ambulatory Care Block (ACB) curriculum.
The ACB was developed as a yearly, one-month required rotation
incorporating elements of geriatric medicine, gender medicine, a
primary care core curriculum and intensive continuity clinic experience,
with a 3-year cyclical curriculum.
Methods: A review of literature, online geriatric modules, and
previous geriatric medicine curriculum was done to expand the ACB
geriatric medicine educational content. Required GeriaSims modules,
didactics, and an Evidence-Based Medicine (EBM) exercise
were adapted from the previous PGY1 experience. We designed a
progressive curriculum with PGY-specific objectives in the context of
a specific theme (Curriculum Year 1 - geriatric assessment; Year 2 -
transitions in care). Geriatric clinical experiences were PGY-specific
(e.g., PGY1 - skilled nursing facility, PGY2 - geriatric clinic, PGY3 -
home visit and Elder Services). A PGY4 chief resident designed a
geriatric morning report as his CRIT project. Residents also completed
a formative COVE-PIM chart review of their continuity clinic
patients. These were added to primary care didactics, quality improvement
project, and continuity and subspecialty clinics. An online
Wiki was created as a resource for schedules, lectures, and independent
assignments.
Results: The ACB pilot year included 28 PGY1 and 29 PGY2
residents. Feedback from residents and faculty was quite positive and
90.5% of the residents agreed or strongly agreed that the integrated
ACB was a better learning experience than the previous separate
components. Feedback led to changes in clinical site scheduling, required
online modules, and structure of the EBM session in the second
year of this rotation.
Conclusions: A geriatric medicine curriculum was successfully
integrated into an ambulatory block rotation for Medicine residents.
Now in its second year the block has been expanded to include PGY3
residents and a new set of didactic sessions and home care clinical experiences
for what will eventually be a three year rotating curriculum.
Overall, we found a valuable geriatric medicine experience may be
incorporated into the ambulatory curriculum for Medicine residents.
A66
Development and Validation of a Novel Geriatric Skills Assessment
Tool (GSAT) to Identify Training Needs of Internal Medicine
Residents and Faculty.
N. Jamshed, 1 P. Zeballos, 1 S. Sinha. 2 1. Internal Medicine,
WHC/Georgetown University School of Medicine, Washington, DC; 2.
University of Toronto, toronto, ON, Canada.
Purpose: This study reports the pilot data and preliminary validation
of a novel, learner-focused, Geriactic Skills Assessment Tool
(GSAT), in assessing training needs in geriatrics at a large academic
community hospital. Methods: A voluntary survey was conducted
amongst the IM faculty and residents using the GSAT. GSAT was developed
based on 15 basic competencies identified by the American
Board of Internal Medicine (ABIM) for IM trainees. Faculty and residents
were each asked to rate their confidence in performing, confidence
in teaching and interest in further training, in each skill set. We
assessed the cronback alpha coefficient for reliability of the GSAT.
Fisher’s exact test was used to evaluate the participant confidence in
performing and teaching particular skills, as well as their interest in
pursuing further training around them. Results: 27 faculty and 27 residents
completed the survey. The cronback alpha coefficient for the
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AGS 2012 ANNUAL MEETING