Social Work's Participation in the Geriatric Education Centers Educational Evaluation: A Brief Report.

This study was conducted to determine the level and types of participation of social workers in the activities of the Geriatric Education Centers (GECs). Through an online survey of GECs, the level of participation of social work professionals was compared with those in dentistry, nursing, medicine, and pharmacy, during the years 2010 to 2014. Thirty-one percent (14) of the 45 GECs completed the survey. The results found increases in participation for both social workers and nurses for both GEC activities and involvement in leadership positions within the centers. The GECs also identified caregiver and provider education and continuing education as activities in which social workers have had an increased interest in recent years. Implications from this study can inform the programming efforts of the new Geriatric Workforce Enhancement Program (GWEP) and other geriatric education programs.

End-of-Life Care in Nursing Homes: A Qualitative Interpretive Meta-Synthesis.

BACKGROUND: Due to large number of deaths occurring in nursing home (NH) settings, along with reports of pain and suffering, there is great need for improvements in the provision of end-of-life (EOL) care in NHs. OBJECTIVE: The aim of this study was to develop a comprehensive understanding of the experience of dying in NHs through the perspective of residents, family, and facility staff. DESIGN: This study uses a qualitative interpretive meta-synthesis to provide a holistic view of EOL care in NHs across multiple qualitative studies. SETTING/SUBJECTS: Researchers synthesized the findings of 13 qualitative articles, including the diverse perspective of 91 dying residents, 419 NH staff, and 156 family members/caregivers across at least 44 NHs. METHODS: A qualitative meta-synthesis employs the following steps: identification of studies, theme extraction, translation, and synthesis of findings. RESULTS: Thematic analysis is organized using a conceptual model demonstrating the links between environmental and personal factors impacting EOL care in NHs. CONCLUSIONS: Findings provide support for the importance of a relational community and culture change within NHs for positive EOL experiences, in addition to providing a model to guide future research priorities.

Making a Difference: A Study of Cognitive Stimulation Therapy for Persons with Dementia.

Affecting nearly 5.4 million older adults in the United States and 35.6 million individuals worldwide, dementia is one of the greatest public health crises of our time. As a result, helping professionals, clients, and care partners seek effective and affordable treatment. Developed in the United Kingdom by Spector and colleagues, Cognitive Stimulation Therapy (CST) is a non-pharmacologic psychosocial group intervention for persons with dementia. To expand upon and fill the gaps within existing research, the authors developed a descriptive study to assess the impact of CST on cognition, quality of life, and depression, among six CST groups (n = 40). A paired sample t-test was run among pre- and post-test measures. There was a statistically significant difference in Saint Louis University Mental Status Exam (SLUMS) scores after CST (t = 2.80, p = 0.008). There was also a statistically significant difference in Cornell Scale for Depression in Dementia scores (t = -3.36, p = 0.002). There was no statistically significant difference in Quality of Life scores.

Non-Pharmacologic Interventions for Persons with Dementia.

Affecting over 100,000 older Missourians, cognitive impairment is of concern for all health care providers. With no available pharmacologic treatments to eradicate/diminish symptoms, professionals and families need non-pharmacologic behavioral interventions to enhance individuals' quality-of-life and decrease the number and intensity of dementia-related behavioral symptoms. This paper provides an overview of available evidence-based non-pharmacologic interventions and strategies that can be delivered in both the community and facility setting, including reminiscence, validation, and cognitive stimulation therapies.

Management of visible granulomas following periorbital injection of poly-L-lactic Acid.

PURPOSE: Injectable poly-L-lactic acid (PLA) is a recently FDA-approved soft-tissue filler. Although approved only for treatment of HIV-associated lipoatrophy, there has been increased interest in its use for cosmetic purposes. Here we describe a case of a granulomatous reaction to injectable PLA in the inferior periorbital region resulting in visible papules and discuss treatment options. METHODS: We review literature pertaining to medical and surgical treatment options for our patient, and we discuss relevant techniques for both the injection of PLA and the management of this complication with surgical techniques. RESULTS: After failing several nonsurgical treatment options, our patient had excellent results with surgical excision of her persistent visible nodules. This technique is minimally invasive, provides definitive removal of the nodules, and can leave minimal residual scarring. CONCLUSIONS: Given the high frequency of subcutaneous nodule formation reported in early trials of injectable PLA, it is important for physicians to be well informed regarding its potential side-effects and how to minimize risk of adverse reactions. Based on our experience, we suggest that surgical excision is an excellent treatment option for persistent papules and nodules that arise after injection of PLA in the periorbital area.

Facial resurfacing for nonmelanoma skin cancer prophylaxis.

OBJECTIVE: To determine the effect of facial skin resurfacing for treatment of actinic keratoses (AKs) and prophylaxis against new primary basal and squamous cell carcinomas in individuals with previous nonmelanoma skin cancer (NMSC) or severe photodamage. DESIGN: Randomized, prospective 5-year trial. SETTING: Dermatology and otolaryngology clinics of a Veterans Affairs hospital. PATIENTS: Thirty-four patients with a history of facial or scalp AKs or basal or squamous cell carcinoma were enrolled. Five of 7 eligible patients who declined study-related treatment were used as controls. Twenty-seven patients were randomized to 3 treatment arms; 3 patients were discontinued from the study. INTERVENTIONS: Carbon dioxide laser resurfacing, 30% trichloroacetic acid peel, or 5% fluorouracil cream applied twice daily for 3 weeks. MAIN OUTCOME MEASURES: Reduction in the number of AKs was measured 3 months after treatment. The incidence of new NMSC in treated areas was assessed between January 1, 2001, and June 30, 2005. Times from baseline to diagnosis of first skin cancer were compared between the treatment and control groups. RESULTS: Treatment with fluorouracil, trichloroacetic acid, or carbon dioxide laser resulted in an 83% to 92% reduction in AKs (P< or =.03), a lower incidence of NMSC compared with the control group (P<.001), and a trend toward longer time to development of new skin cancer compared with the control group (P=.07). However, no significant differences were noted among the treatment groups. CONCLUSION: All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.

Wingless signaling modulates cadherin-mediated cell adhesion in Drosophila imaginal disc cells.

Armadillo, the Drosophila homolog of beta-catenin, plays a crucial role in both the Wingless signal transduction pathway and cadherin-mediated cell-cell adhesion, raising the possibility that Wg signaling affects cell adhesion. Here, we use a tissue culture system that allows conditional activation of the Wingless signaling pathway and modulation of E-cadherin expression levels. We show that activation of the Wingless signaling pathway leads to the accumulation of hypophosphorylated Armadillo in the cytoplasm and in cellular processes, and to a concomitant reduction of membrane-associated Armadillo. Activation of the Wingless pathway causes a loss of E-cadherin from the cell surface, reduced cell adhesion and increased spreading of the cells on the substratum. After the initial loss of E-cadherin from the cell surface, E-cadherin gene expression is increased by Wingless. We suggest that Wingless signaling causes changes in Armadillo levels and subcellular localization that result in a transient reduction of cadherin-mediated cell adhesion, thus facilitating cell shape changes, division and movement of cells in epithelial tissues.