Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton

OBJECTIVES: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents. DESIGN AND METHODS: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed. RESULTS: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring. CONCLUSION: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. It should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents

Diabète et conduite: réflexions et atelier pratique [Diabetes and driving: thoughts and educational perspectives].

In Switzerland over 200'000 people with diagnosed diabetes drive a car. Their physicians endorse many roles: usual medical care as well as informing properly about driving recommandations and handling the legal issues behing the licensing procedure. Ability to drive can be impaired in three ways: hypogylcemia, diabetes complications and hyperglycemia. Hypoglycemia is the main risk factor of vehicle accident for diabetic drivers and frequent while driving. However few accidents are reported due to hypoglycemia. Swiss medical guidelines about diabetes and driving mention the requested conditions, but practically how should we do? We sought to answear by creating a specific educationnal program focused on hypoglycemia management. Building patient knowledges through experiences is the main goal of the course diabetes and driving.

Iowa Educational Directory, 2013-2014

Annual directory of PreK-12, area education agencies, universities, colleges, and the Iowa Department of Education

Etude prospective d'évaluation psychiatrique et pédagogique dans un service pour adolescents de la Fondation Santé des Etudiants de France. Méthodologie et résultats préliminaires [Prospective study of psychiatric and pedagogic evaluation of the adolescent service of the Student Health Foundation of France. Methodology and preliminary results].

The present prospective study, with a five-year follow-up, presents an extensive psychiatric and educational assessment of an adolescent population (N = 30) in the age range 14-20, suffering from several psychiatric disorders, though apt to follow a normal academic program. The residential settings where the study took place provide both psychiatric and schooling facilities. In this environment, what is the effectiveness of long-term hospitalization? Are there any criteria for predicting results? After discharge, could social adjustments difficulties be prevented? Assessment instruments are described and the results of one preliminary study are presented. The actual data seems to confirm the impact of the special treatment facilities combining schooling and psychiatric settings on the long term outcome of adolescents.

Improving Traffic Safety Culture in Iowa, 2011

Vehicle crashes rank among the leading causes of death in the United States. In 2006, the AAA Foundation for Traffic Safety “made a long- term commitment to address the safety culture of the United States, as it relates to traffic safety, by launching a sustained research and educational outreach initiative.” An initiative to produce a culture of safety in Iowa includes the Iowa Comprehensive Highway Safety Plan (CHSP). The Iowa CHSP “engages diverse safety stakeholders and charts the course for the state, bringing to bear sound science and the power of shared community values to change the culture and achieve a standard of safer travel for our citizens.” Despite the state’s ongoing efforts toward highway safety, an average of 445 deaths and thousands of injuries occur on Iowa’s public roads each year. As such, a need exists to revisit the concept of safety culture from a diverse, multi-disciplinary perspective in an effort to improve traffic safety. This study summarizes the best practices and effective laws in improving safety culture in the United States and abroad. Additionally, this study solicited the opinions of experts in public health, education, law enforcement, public policy, social psychology, safety advocacy, and traffic safety engineering in a bid to assess the traffic safety culture initiatives in Iowa. Recommendations for improving traffic safety culture are offered in line with the top five Iowa CHSP safety policy strategies, which are young drivers, occupant protection, motorcycle safety, traffic safety enforcement and traffic safety improvement program, as well as the eight safety program strategies outlined in the CHSP. As a result of this study, eleven high-level goals were developed, each with specific actions to support its success. The goals are: improve emergency medical services response, toughen law enforcement and prosecution, increase safety belt use, reduce speeding-related crashes, reduce alcohol-related crashes, improve commercial vehicle safety, improve motorcycle safety, improve young driver education, improve older driver safety, strengthen teenage licensing process, and reduce distracted driving.

GWAS of 126,559 individuals identifies genetic variants associated with educational attainment.

A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.

Audit report on the Office of Treasurer of State, Iowa Educational Savings Plan Trust (Trust) for the year ended June 30, 2015

Audit report on the Office of Treasurer of State, Iowa Educational Savings Plan Trust (Trust) for the year ended June 30, 2015

Memòria Practicum II : Gestió de Serveis Sanitaris, Hospital de Sta Maria de Lleida, Unitat d'Aguts, Servei de Psiquiatria

Memòria del Practicum II realitzat a la Unitat d'aguts del Servei de Psiquiatria de l'Hospital de Santa Maria a Lleida.

Formación permanente y construcción de identidades en el Equipo docente del practicum de Educación Social

El objetivo de esta comunicación es presentar la experiencia formativa de aprendizaje en elseno del Equipo Docente de la asignatura del practicum del Grado Educación Social, así comolos procesos de construcción identitaria derivados de la misma. Tratamos de analizar esta experienciacomo espacio de generación de conocimiento pedagógico a partir de la reflexión yla formación que nos brinda la propia práctica docente compartida en el equipo. Proponemosabordar los puntos medulares que dan cuenta de la sistematización de una práctica de formaciónpermanente a partir de la reflexión “en”, “sobre” y “desde” la acción. Es a partir de estasconsideraciones que nos incardinaremos en el proceso de transformación y construcciónde la identidad docente. Para ello, hemos creído oportuno identificar los elementos que coadyuvan en el complejo proceso identitario, para pasar a su posterior análisis.

Formación permanente y construcción de identidades en el Equipo docente del practicum de Educación Social

El objetivo de esta comunicación es presentar la experiencia formativa de aprendizaje en elseno del Equipo Docente de la asignatura del practicum del Grado Educación Social, así comolos procesos de construcción identitaria derivados de la misma. Tratamos de analizar esta experienciacomo espacio de generación de conocimiento pedagógico a partir de la reflexión yla formación que nos brinda la propia práctica docente compartida en el equipo. Proponemosabordar los puntos medulares que dan cuenta de la sistematización de una práctica de formaciónpermanente a partir de la reflexión “en”, “sobre” y “desde” la acción. Es a partir de estasconsideraciones que nos incardinaremos en el proceso de transformación y construcciónde la identidad docente. Para ello, hemos creído oportuno identificar los elementos que coadyuvan en el complejo proceso identitario, para pasar a su posterior análisis.

Formación permanente y construcción de identidades en el Equipo docente del practicum de Educación Social

El objetivo de esta comunicación es presentar la experiencia formativa de aprendizaje en elseno del Equipo Docente de la asignatura del practicum del Grado Educación Social, así comolos procesos de construcción identitaria derivados de la misma. Tratamos de analizar esta experienciacomo espacio de generación de conocimiento pedagógico a partir de la reflexión yla formación que nos brinda la propia práctica docente compartida en el equipo. Proponemosabordar los puntos medulares que dan cuenta de la sistematización de una práctica de formaciónpermanente a partir de la reflexión “en”, “sobre” y “desde” la acción. Es a partir de estasconsideraciones que nos incardinaremos en el proceso de transformación y construcciónde la identidad docente. Para ello, hemos creído oportuno identificar los elementos que coadyuvan en el complejo proceso identitario, para pasar a su posterior análisis.

Educational Opportunity through The Advocate

This communication tool comes from the Office of the State Long-Term Care Ombudsman to long-term care facilities administrators and directors. The Office's objective is to share information regarding various topics of long term care.