Developing and pilot testing a frailty-focused education and communication training workshop.

Objective: To describe development and pilot testing of a multi-modal frailty-focused education and communication training workshop for health care clinicians. Methods: Pilot testing was conducted via two workshops (#1:face-to-face [2019], #2:virtual [2020]). Participants: convenience sample of clinicians and students who volunteered. Workshop #1 included registered nurses working in an acute care and one medical student (N=14); #2: nursing students enrolled in an APRN program. Design: Pre/post observational study. Data analysis: descriptive statistics, paired t-tests and Wilcoxon rank test. Results: Statistically significant increases in frailty knowledge (#1: p = 0.02, d = 0.44; #2: p = 0.006, d = 0.55) and self-reported competency with older adult interactions (#1: p < 0.001, d = 0.62; #2: p = 0.001, d = 0.63) were reported for both workshops. Post course evaluations of the workshop were positive, with scores ranging from 3.5-3.9 (range: 0-4) for increased understanding of the concept of frailty, communication to support health-related behavior, and best practice empathic communication skills. Conclusion: The FCOM workshop was successful. Participants gained knowledge and skills for use in working with older adults across the aging continuum from non-frail to frail. Innovation: Our FCOM training workshop expands prior communication training on shared decision-making with frail individuals to a broader population of all older adults.

"This Is Me!" Perceptions of Older Adult Simulated Participants in an Aging and Injury Simulation Experience.

BACKGROUND: Older adults played the role of frail and prefrail geriatric trauma patients in a frailty-focused communication workshop for nurses. Although subjects played a role (acting) as simulated participants (SPs) for simulation, workshop content and role-play also applied to them personally. We aimed to explore the effect that learning frailty-focused content, scripts, and portrayal of prefrail and frail older adults has on older adult SPs. METHODS: Qualitative focus group. Participants included older adults older than 70 years (N = 6). PROCEDURE: Focus group questions pertained to (1) the SP experience, (2) thoughts and emotions throughout the SP experience, and (3) applicability of workshop content and SP experience to personal life. The focus group lasted 90 min, was digitally recorded, and transcribed verbatim. Authors independently coded transcripts to identify categories and supporting quotations. Categories and subcategories were condensed and modified through iterative discussions. Descriptive content analysis was utilized for data analysis. RESULTS: Six categories and 2 subcategories emerged, including (1) inevitability of aging: not playing a role (sub: inevitability of death), (2) shifting perceptions: how aging impacts thought and actions, (3) time as a factor: getting information sooner, (4) changing behavior/safety: mental recalibration, (5) attitude as a determining factor (sub: loss of independence), and (6) sharing information with others. CONCLUSION: The study supports the use of frailty-focused communication with older adults to prompt contemplation of aging and frailty and eventual decline/death. Providing information earlier in the aging trajectory enables time for behavior change that can prevent and delay frailty and mitigate untoward outcomes (falls, hospitalizations).

Childhood autism: a circuit syndrome?

BACKGROUND: Autism is a disorder that can lead to life-long disability. Currently, the etiology of autism is unknown, and although there are treatments for some of the behavioral abnormalities, there is no cure. REVIEW SUMMARY: While this article will review the clinical, anatomic, and pathologic features seen in autism, the primary focus will be to present a new and provocative unifying theory regarding the underlying mechanisms causing this disorder. Current research advances, some controversial, will be discussed, and a novel definition of autism as a "circuit syndrome" will be presented. The work elaborated here will tie many of the disparate findings together, based on the idea that autism arises from abnormalities of the cerebellolimbic circuitry. Some of the more alternative theories of autism, such as mercury toxicity, linkage to the measles, mumps, and rubella vaccine, and the use of secretin will be discussed. Finally, pharmacologic treatment options will be reviewed. CONCLUSIONS: Autism is not single disorder but represents dysfunction of the cerebellolimbic circuitry that can arise from many different etiologies.

Atypical features of medulloblastoma on magnetic resonance imaging: case report and review of the literature.

Magnetic resonance imaging (MRI) is the radiologic modality of choice used to evaluate suspected lesions in the posterior fossa, given its greater sensitivity compared with other neuroimaging techniques. The case of a 9-year-old girl with progressive ataxia is presented. MRI of the brain demonstrated nonspecific T2-weighted abnormalities involving the cerebellar vermis with minimal mass effect suggested by asymmetric enlargement of the left superior cerebellar peduncle. Postgadolinium studies showed only minimal enhancement of the left superior cerebellar peduncle. After an MRI of the spine demonstrated drop metastases, a cerebellar biopsy was performed, which revealed an infiltrating medulloblastoma confined to the granular layer and leptomeninges. Hence, MRI is an important ancillary tool in the diagnosis of medulloblastoma, but caution needs to be taken when interpreting imaging studies.