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Management of Infections in Advanced Dementia

Course Description | Faculty | Accreditation | General Information

Course Description

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 1 credit of Risk Management Study. This includes 1 Credit of End-of-Life Care Studies.

Please check your individual state licensing board requirements before claiming these credits.


Antimicrobial use is extensive in advanced dementia. However, prior research suggests much of this use may not be appropriate. This interactive, computer based, self-directed course illustrates key concepts in the management of infections in advanced dementia, consensus-based algorithms for antimicrobial initiation, and integration of resident preferences into treatment decisions. The course consists of 4 virtual patient cases: 2 for urinary tract infections and 2 for lower respiratory tract infections. Participants receive response-specific, evidence-based feedback to answers, as well as supplemental information.

Original Release: 1/3/2012
Most Recent Update: 9/5/2013
Termination Date: 9/5/2016

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

COST: $20.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.

OVERALL LEARNING OBJECTIVES:
By participating in this course, learners will be able to:

  1. Explain the clinical course of lower respiratory and urinary tract infections in advanced dementia.
  2. Identify the minimum criteria to initiate antimicrobials for a suspected lower respiratory tract and urinary tract infections in advanced dementia.
  3. Integrate patient preferences in treatment decisions for lower respiratory and urinary tract infections for nursing home residents with advanced dementia

CLINICAL LEARNING OBJECTIVES:

  1. Reduce inappropriate use of antimicrobials among nursing home residents with advanced dementia with suspected lower respiratory and urinary tract infections in advanced dementia
  2. Align patient preferences with treatment of lower respiratory and urinary tract infections in advanced dementia in nursing home residents with advanced dementia
  3. Decrease hospitalization rates of nursing home residents with advanced dementia for lower respiratory and urinary tract infections

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Faculty
SUSAN MITCHELL, MD, MPH
Course Director
Dr. Susan L. Mitchell, MD, MPH. a geriatrician and clinical researcher, is a Professor of Medicine at Harvard Medical School and Senior Scientist at the Hebrew Senior Life Institute for Aging Research in Boston. She is a graduate of the University of Ottawa Medical School, and has a Master’s degree in Public Health from the Harvard School of Public Health. Dr. Mitchell’s research focuses on decision-making, health outcomes and resource utilization for older persons with advanced dementia. She is currently the Principal Investigator on several large NIH funded grants that aim to improve the end-of-life experience for patients with advanced dementia and their families.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ERIKA D'AGATA, MD, MPH
Course Co-Director
Dr.Erika D’Agata is an Associate Professor at Harvard Medical School and is an Infectious Diseases physician in the Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA. She obtained her medical degree at the University of Toronto in 1990 and completed her internal medicine residency training at the same university in 1993. Thereafter, she completed her Infectious Disease Fellowship at the Deaconess Hospital, Harvard Medical School in 1997. After a few years at the Vanderbilt University in the Division of Infectious Diseases, she returned to Boston in 2001, where she practices at the Beth Israel Deaconess Medical Center. Dr.D’Agata’s main research focus is the characterization of the transmission dynamics of antimicrobial-resistant bacteria using clinical and molecular techniques. High-risk populations currently under study are the chronic hemodialysis population and residents of long-term care facilities. Dr.D’Agata uses mathematical modeling to further define the transmission dynamics of antimicrobial-resistant pathogens.

DISCLOSURE:
The commercial entities with which we have relationships do not produce, market, re-sell, or distribute health care goods or services relevant to the content I am planning, developing, presenting, or evaluating for the activity.



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Reviewers
RANDI BERKOWITZ, MD
Reviewer
Dr. Randi Berkowitz is a geriatrician at Hebrew SeniorLife in Boston, Massachusetts. She is the medical director for subacute care for Hebrew SeniorLife, which has a 50-bed Recuperative Services Unit (RSU) in Boston and a 48-bed RSU in Dedham. She is an Instructor of Medicine at Harvard Medical School. She graduated from Barnard College, University of Chicago Medical School, and the Harvard Geriatric Fellowship, and completed the Practice Change Fellows Program, a two-year national fellowship program designed to build leadership capacity among nurses, physicians, and social workers who have operations-level responsibility for geriatric programs and service lines. The rehospitalization project at Hebrew SeniorLife, developed by Dr. Randi Berkowitz during her participation in the University of Colorado Denver’s Practice Change Fellows Program has succeeded in reducing the number of acute patients transferred from a SNF unit to the hospital by 20%. This reduction has been accomplished via a multipronged approach, which includes standardizing the physician admission process, identifying high risk patients who might benefit from palliative care consults, improving team communication, learning from cases of avoidable readmissions, standardizing the home discharge process, and sharing knowledge with referring hospitals. A description of this project was published in June 2011 in the Journal of the American Geriatrics Society and has received national attention, including an article in USA Today.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



SARAH BERRY, MD
Reviewer
Dr. Berry is a Assistant Professor at Harvard Medical School. Geriatrician, clinical researcher, and Instructor in Medicine at Beth Israel Deaconess Medical Center and Hebrew SeniorLife, Boston, MA. Her primary research focus has been on outcomes following hip fractures, both in the community and nursing home settings. She is additionally interested in studying falls and fall prevention measures. Her current research will examine the temporal effects of medication changes on the acute risk of falls in the nursing home setting.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ANGELA CATIC, MD
Reviewer
Dr. Angela Catic, a geriatric clinician educator at Beth Israel Deaconess Medical School and Harvard Medical School, is the recipient of a Hartford Center for Excellence Research Fellowship Award and two Geriatric Academic Career Awards. She utilized these awards to develop multidisciplinary educational programs regarding the safety of elders during acute hospitalization. Particular areas of focus include pain management; delirium prevention and management; successful care transitions; and appropriate care of elders with advanced dementia.

Dr. Catic also co-directs ECHO-AGE, a tele-medicine educational program which trains long term care providers in the management of elders with dementia and associated behavioral issues. She holds a number of leadership roles including directing the Harvard Geriatric Medicine Fellowship program, leading the fourth year Harvard Medical School geriatric elective, and directing the educational component of the geriatric elective for internal medicine residents at Beth Israel Deaconess Medical Center.

DISCLOSURE:
The commercial entities with which we have relationships do not produce, market, re-sell, or distribute health care goods or services relevant to the content I am planning, developing, presenting, or evaluating for the activity.



GRACE HUANG, MD
Reviewer
Grace Huang, MD, is the Director of the Office of Educational Technology at the Carl J. Shapiro Institute for Education and Research, a joint venture between HMS and Beth Israel Deaconess Medical Center (BIDMC) in Boston. She also works as a hospitalist at BIDMC. She has spent a number of years designing web-based modules on clinical skills, including computer-based case simulations (“virtual patients”), physical diagnosis tutorials, interactive pathophysiology diagrams, and procedure-based instruction. She serves as a consultant to the Association of American Medical Colleges in their initiative to promote scholarship and sharing of educational materials through MedEdPORTAL. Her clinical research interest is in the impact of a formal hospital-based procedure service on complication rates among internal medicine residents.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ZALDY TAN, M.D., M.P.
Reviewer
Dr. Zaldy S. Tan is Assistant Professor of Medicine at Harvard Medical School and Director of Education at the Brigham and Women's Hospital Division of Aging and the GRECC, VA Boston Healthcare System. He is an investigator at the Framingham Heart Study, where his research focuses on the risk and protective factors for dementia. Dr Tan was the founding director of the Memory Disorders Clinic at the Beth Israel Deaconess Medical Center. His current clinical practice focuses on the promotion of healthy aging and the prevention of disease. He is also Associate Program Director of the Harvard Geriatric Medicine Fellowship and performs research on the use of instructional technology in quality improvement initiatives for older patients.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



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Course Planners
RUTH P. CARROLL, RN
Planner
Ruth P. Carroll has 35 plus years in geriatric nursing. She previously functioned as Clinical Coordinator with shared responsibility for a 725-bed chronic disease hospital, Clinical Instructor, MMQ/Case Mix Coordinator, MDS and Infection Control Coordinator, and Staff Development Coordinator. In addition, she has extensive teaching and management skills.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



SANJIV CHOPRA, MD
Planner
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ANDI LONG, EdM
Planner
Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



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Accreditation

NUMBER OF CREDITS: 1 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate


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General Information

HARDWARE/SOFTWARE REQUIREMENTS

Computers
Any computer running Windows, Mac OS, or Unix machines are supported.


Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Browsers
Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Plugins
Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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