Reducing the risk of adverse drug events in older adults.

Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time. Common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium. The most common causes of death are gastrointestinal or intracranial bleeding and renal failure. Antithrombotic and antidiabetic medications, diuretics, and nonsteroidal anti-inflammatory drugs cause most of the preventable hospital admissions due to adverse drug events. Strategies to reduce the risk of adverse drug events include discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications. The Beers, STOPP (screening tool of older persons' potentially inappropriate prescriptions), and START (screening tool to alert doctors to right treatment) criteria can help identify medications causing adverse drug events. Not all potentially inappropriate medications can be avoided. Clinicians should involve patients in shared decision making and individualize prescribing decisions based on medical, functional, and social conditions; quality of life; and prognosis.

Where do they come from and where do they go: implications of geographic origins of medical students.

BACKGROUND: Can prior places of residence listed on a medical school application predict where a physician will practice in midcareer? METHOD: Geographic data were analyzed for a cohort of 399 graduates from a single U.S. medical school. RESULTS: Applicants with origins in the local region had a 40.4% to 49.5% probability of practicing locally in midcareer--an increased likelihood of 6.1 to 7.3 (P < .001) by bivariate analysis. In a logistic regression analysis, residence at birth (odds ratio [OR] = 2.6, P = .019) and at college graduation (OR = 2.8, P = .001) were significant predictors of midcareer practice location, but residence at high school graduation and on application to medical school were not. CONCLUSIONS: Midcareer practice location is related to geographic origins. Using multiple indicators of geographic origins available at the time of application can allow admissions committees to make higher-quality decisions.

The effect of educational games on medical students' learning outcomes: a systematic review: BEME Guide No 14.

BACKGROUND: An educational game is 'an instructional method requiring the learner to participate in a competitive activity with preset rules.' A number of studies have suggested beneficial effects of educational games in medical education. AIM: The objective of this study was to systematically review the effect of educational games on medical students' satisfaction, knowledge, skills, attitude, and behavior. METHODS: We used the best evidence medical education (BEME) collaboration methods for conducting systematic reviews. We included randomized controlled trials (RCT), controlled clinical trials, and interrupted time series. Study participants were medical students. Interventions of interest were educational games. RESULTS: The title and abstract screening of the 1019 unique citations identified 26 as potentially eligible for this article. The full text screening identified five eligible papers, all reporting RCTs with low-to-moderate methodological quality. Findings in three of the five RCTs suggested but did not confirm a positive effect of the games on medical students' knowledge. CONCLUSION: The available evidence to date neither confirm nor refute the utility of educational games as an effective teaching strategy for medical students. There is a need for additional and better-designed studies to assess the effectiveness of these games and this article will inform this research.