Geriatric Assessment in a Primary Care Environment: A Standardized Patient Case Activity for Interprofessional Students.

Introduction: Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions. Methods: Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity. Results: Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork. Discussion: Reflective comments from students regarding the interprofessional experience are evidence of this initiative's benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.

Lactobacillus and bifidobacteria combinations: a strategy to reduce hospital-acquired Clostridium difficile diarrhea incidence and mortality.

Incidence and virulence of Clostridium difficile-associated disease (CDAD) is increasing, particularly in institutional settings. Morbidity, mortality, and costs associated with this condition are high. Broad-spectrum antibiotics have long been recognized as the primary risk factor for CDAD due to disruption of protective normal gastrointestinal flora. We suggest that administration of appropriate lactobacilli and bifidobacteria probiotics could be employed as a strategy to protect hospitalized patients from CDAD by normalizing disrupted gastrointestinal flora, resulting in fewer cases per admission. Routine use of probiotics within institutional settings may substantially decrease healthcare costs. To date, relatively little is known about the role of probiotics as a means of preventing initial CDAD diagnosis. Although two reports suggestive of benefits have been published, these studies have been either too under-powered to draw definitive conclusions or have employed such restrictive inclusion criteria that results are not generalizable to most hospitalized adults. Since CDAD is an opportunistic infection associated with disrupted gut flora, it is logical to employ a strategy that modulates gut flora as a preventative approach. Herein, we report pilot data that is strongly suggestive that bifidobacteria and lactobacilli combinations may be effective in preventing this hospital-acquired infection and possibly reducing severity when diagnosed. These data are generalizable to all hospital patients since few exclusion criteria were employed. Limitations to these data are acknowledged since the pilot was not conducted in a placebo-controlled manner. Although generalizable, lack of a placebo precludes a definitive answer in terms of efficacy that lactobacilli and bifidobacteria may provide in CDAD prevention. Given substantial morbidity, mortality, and healthcare costs associated with CDAD, appropriately-designed clinical trials are warranted.