Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Skilled Nursing Facility Residents and Staff Members-Los Angeles County, August-September 2020.

BACKGROUND: The prevalence of current or past coronavirus disease 2019 in skilled nursing facility (SNF) residents is unknown because of asymptomatic infection and constrained testing capacity early in the pandemic. We conducted a seroprevalence survey to determine a more comprehensive prevalence of past coronavirus disease 2019 in Los Angeles County SNF residents and staff members. METHODS: We recruited participants from 24 facilities; participants were requested to submit a nasopharyngeal swab sample for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing and a serum sample for detection of SARS-CoV-2 antibodies. All participants were cross-referenced with our surveillance database to identify persons with prior positive SARS-CoV-2 results. RESULTS: From 18 August to 24 September 2020, we enrolled 3305 participants (1340 residents and 1965 staff members). Among 856 residents providing serum samples, 362 (42%) had current or past SARS-CoV-2 infection. Of the 346 serology-positive residents, 199 (58%) did not have a documented prior positive SARS-CoV-2 PCR result. Among 1806 staff members providing serum, 454 (25%) had current or past SARS-CoV-2 infection. Of the 447 serology-positive staff members, 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR result. CONCLUSIONS: Past testing practices and policies missed a substantial number of SARS-CoV-2 infections in SNF residents and staff members.

Tuberculosis in Older Adults.

Tuberculosis (TB) remains one of the world's most lethal infectious diseases. Preventive and control strategies among other high-risk groups, such as the elderly population, continues to be a challenge. Clinical features of TB in older adults may be atypical and confused with age-related diseases. Diagnosis and management of TB in the elderly person can be difficult; treatment can be associated with adverse drug reactions. This article reviews the current global epidemiology, pathogenesis, clinical characteristics, diagnosis, management, and prevention of Mycobacterium tuberculosis infection in community-dwelling and institutionalized aging adults.

Infectious Diarrhea: Norovirus and Clostridium difficile in Older Adults.

Norovirus infection usually results in acute gastroenteritis, often with incapacitating nausea, vomiting, and diarrhea. It is highly contagious and resistant to eradication with alcohol-based hand sanitizer. Appropriate preventative and infection control measures can mitigate the morbidity and mortality associated with norovirus infection. Clostridium difficile infection is the leading cause of health care-associated diarrhea in the United States. Antibiotic use is by far the most common risk factor for C difficile colonization and infection. Appropriate preventive measures and judicious use of antibiotics can help mitigate the morbidity and mortality associated with C difficile infection.

Norovirus Infections in Long-Term Care Facilities.

Noroviruses have emerged as one of the leading causes of viral gastroenteritis worldwide, affecting community-dwelling and institutionalized older adults. Recent global epidemics present a growing challenge to the healthcare system and to long-term care facilities. Noroviruses spread readily and rapidly through multiple routes (e.g., person-to-person contact, contact with contaminated surfaces, airborne dissemination of vomitus) and thus are able to sustain an epidemic efficiently and successfully. Although norovirus gastroenteritis is a short self-limited illness in healthy immunocompetent individuals, it can result in significant morbidity and mortality in vulnerable compromised persons such as frail elderly persons and older residents of nursing homes. Diagnosis is made by clinical assessment and confirmed primarily by stool evaluation using polymerase chain reaction. Treatment is confined to supportive measures. Public health prevention and control strategies provide guidance regarding surveillance and the necessary steps to curb the clinical effect and spread of norovirus infections in various settings, including long-term care.

A framework for developing, implementing, and evaluating a cancer survivorship curriculum for medical students.

BACKGROUND: Cancer survivorship care is not adequately addressed in current medical school curricula. OBJECTIVES: To develop, implement, and evaluate a modular cancer survivorship curriculum that is portable to other educational settings and is designed to provide medical students with a foundation of knowledge, attitudes, and skills related to care for cancer survivors. PROGRAM DESCRIPTION: An expert consensus panel developed a set of learning objectives related to cancer survivorship to guide the development of educational modules, such as computer-based self-instructional modules, problem-based learning cases, videos, and clinical exercises. Course and clerkship chairs were directly involved in the development and implementation of the modules. EVALUATION: A cohort study with a historical control group demonstrated that fourth-year medical students increased their knowledge in survivorship issues and their self-reported level of comfort in care activities compared to similar students who did not receive the survivorship curriculum. CONCLUSIONS: Our framework resulted in a cancer survivorship curriculum that was implemented in a modular manner across the medical curriculum that improved learning and that is potentially portable to other educational settings.

Preparedness for caring of cancer survivors: a multi-institutional study of medical students and oncology fellows.

BACKGROUND: Despite recent advances in cancer survivorship knowledge and care, most medical schools lack a comprehensive survivorship curriculum, potentially leaving students ill-prepared for caring of survivors. METHODS: A total of 211 students and 22 oncology fellows in 3 institutions completed a questionnaire assessing knowledge and experience in survivorship care. RESULTS: Medical students and oncology fellows lack knowledge in key survivorship issues. Students were exposed to cancer survivors frequently in medical school but only half received instruction or practiced critical components of survivorship care. CONCLUSIONS: Improvement of both undergraduate and postgraduate training in survivorship care is urgently warranted.

Using virtual patients to improve cardiac examination competency in medical students.

BACKGROUND: Cardiac examination (CE) skills are in decline. Most prior studies employed audio recordings, evaluating only one aspect of CE (i.e., auscultation) that precluded correlation with visible observations. To address these deficiencies, we developed a curriculum using virtual patient examinations (VPEs); bedside recordings of patients with visible and audible cardiovascular findings presented as interactive multimedia. HYPOTHESIS: The purpose of this study was to evaluate whether VPEs improve CE skills, and whether any improvements are retained. We assessed CE competency overall and in 4 categories: inspection, auscultation, knowledge, and integration of audio and visual skills. METHODS: Students (n = 24) undergoing the 8-wk Internal Medicine (IM) clerkship rotation and receiving supervised instruction with VPEs (intervention group) were compared with students (n = 58) undergoing IM clerkship rotation without supplemental CE instruction (control group). The groups were tested at the beginning and the end of their rotations. RESULTS: The Intervention group improved significantly in overall mean scores: from 58.7 to 73.5 (p = 0.0001). The Control group did not improve: from 60.1 to 59.5 (p = 0.788). The Intervention group improved inspection, auscultation, and knowledge (all p

Impact of the University of California, Los Angeles/Charles R. Drew University Medical Education Program on medical students' intentions to practice in underserved areas.

PURPOSE: To estimate the impact of a U.S. inner-city medical education program on medical school graduates' intentions to practice in underserved communities. METHOD: The authors conducted an analysis of secondary data on 1,088 medical students who graduated from either the joint University of California, Los Angeles/Charles R. Drew University Medical Education Program (UCLA/Drew) or the UCLA School of Medicine between 1996 and 2002. Intention to practice in underserved communities was measured using students' responses to questionnaires administered at matriculation and graduation for program improvement by the Association of American Medical Colleges. Multivariate logistic regression analysis was used to compare the odds of intending to practice in underserved communities among UCLA/Drew students with those of their counterparts in the UCLA School of Medicine. RESULTS: Compared with students in the UCLA School of Medicine, UCLA/Drew students had greater adjusted odds of reporting intention to work in underserved communities at graduation, greater odds of maintaining or increasing such intentions between matriculation and graduation, and lower odds of decreased intention to work in underserved communities between matriculation and graduation. CONCLUSIONS: Training in the UCLA/Drew program was independently associated with intention to practice medicine in underserved communities, suggesting that a medical education program can have a positive effect on students' goals to practice in underserved areas.

Serious infections in elderly patients with diabetes mellitus.

The elevated serum glucose levels associated with diabetes mellitus (DM) alter host immune responses, resulting in a well-documented increase in the predisposition to infectious processes. Furthermore, the cumulative effect of age-related immune senescence, superimposed on this enhanced risk of infections, can lead to serious and life-threatening infections in elderly patients with DM. Because infection associated with aging can frequently present in a subtle and atypical manner, prompt recognition of infection and treatment with appropriate empirical broad-spectrum antimicrobial agents, in conjunction with surgical intervention, is often necessary to eradicate such infections. Common sites of serious infection associated with DM include the head and neck, biliary tract, and urinary tract, as well as the skin, soft tissue, and bony structures of the feet in particular.