Training in elder abuse: the experience of higher specialist trainees in Geriatric Medicine in the UK.

Little is known about elder abuse training in post-graduate medical education in the United Kingdom. A questionnaire survey was conducted among Specialist Registrars (SpRs) in Geriatric Medicine attending a single training day within five UK Post-graduate Deaneries to assess self-report experience of elder abuse training during their post-graduate medical education. The questionnaire included quantity, quality and self-report confidence in dealing with elder abuse issues. A total of 112 questionnaires were returned (response rate 100%, representing 78.9% of eligible trainees within these five deaneries). The majority of the participants rated low scores for both quantity and quality of training they received. This finding was consistent across all 5 years of training with no significant difference in rating scores in more experienced (years 3-5) SpRs. The majority (62.5%) of final year SpRs reported feeling inadequately prepared to deal with cases of elder abuse. The results of our survey suggest that the provision and quality of training regarding elder abuse is poor for trainees in Geriatric Medicine. The majority of SpRs approaching the completion of their training felt ill-prepared in managing such cases. Our study highlights the requirement of structured approach in elder abuse training for trainees in Geriatric Medicine.

Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke?

BACKGROUND: Dysphagia occurs in up to 50% of patients admitted to hospital with acute strokes with up to 27% remaining by seven days. Up to 8% continue to have swallowing problems six months after their stroke with 1.7% still requiring enteral feeding. Nasogastric tubes (NGT) are the most commonly used method for providing enteral nutrition in early stroke, however they are easily and frequently removed leading to inadequate nutrition, early PEG (Percutaneous Endoscopic Gastrostomy) insertion or abandoning of feeding attempts. Looped nasogastric tube feeding may improve the delivery of nutrition to such patients. METHODS: Three centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability. TRIAL REGISTRATION: ISRCTN Number: ISRCTN61174381.