The competency-based medical education movement has been adopted in several medical education systems across the world. This has the potential to result in a more active involvement of residents in the educational process, inasmuch as scholarship is regard

Immunosuppressants, particularly tacrolimus, can induce neurotoxicity in solid organ transplantation cases. A lower clinical threshold to switch from tacrolimus to another immunosuppressant agent has been a common approach to reverse this neurotoxicity. Ho

Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs.ED encounters

Background

Hypovitaminosis D is unrecognized and remarkably common in geriatric patients, with various clinical manifestations. The purpose of this study was to prospectively assess the vitamin D (VD) status in newly admitted psychogeriatric patients, and to study the correlation of VD status with indicators of calcium metabolism.

Methods

A valid VD sample, as measured by serum 25-hydroxyvitamin D (25-OHD), was obtained from nine consecutive psycogeriatric inpatients (66% women), during a one-month period in 2011. The Research Ethics Boards at St. Joseph's Healthcare Hamilton approved this project.

Results

All participants showed VD inadequacy (defined as 25-OHD ≤ 75 nmol/L) with a mean level of serum 25-OHD of 45.5 ± 14.6 (range 28.5-73.4) nmol/L. None of the patients in the sample met criteria for VD deficiency (currently defined by expert consensus as 25-OHD < 25 nmol/L). Mean serum VD levels were lower in females (38.8 ± 9.8 nmol/L) than in males (59.0 ± 14.3 nmol/L), p = .03. Magnesium and PTH were both higher in females (p = .03 and .02, respectively). Univariate linear regression analysis showed that VD levels were strongly negatively associated with magnesium (p = .001) and PTH (p = .02).

Conclusion

Since research links VD deficiency to psychiatric conditions, high rates of insufficiency in this population is very common and routine supplements are strongly suggested, regardless of patients' living environment.

An important aspect of academic medicine is publication in peer-reviewed journals and other media. Early scholarly productivity in medical school may jump-start a successful academic career. Topic choice, search methodology, writing strategies, mentorship, and collaboration are all fundamental to successful academic productivity. The authors reviewed the importance of instituting the germinal stages of scholarly productivity during medical training and created 12 steps for facilitating productive academic writing by students.

Background

As vitamin D may have a neuroprotective effect, the authors studied the association of biomarkers of vitamin D status and delirium to see if low vitamin D status was common in delirium cases.

Methods

Biochemical measures of vitamin D (25-hydroxyvitamin D [25-OHD]) and calcium metabolism were used in this retrospective cross-sectional analysis of adult in-patients with delirium, admitted at three Canadian academic hospitals from January 2011 to July 2012. Primary outcome was to determine estimates of the prevalence of hypovitaminosis D in this group in whom vitamin D was checked.

Results

Seventy-one (5.8%) out of 1,232 delirium inpatients had their vitamin D measured. Thirty-nine (55%) showed vitamin D insufficiency (25-OHD of 25-75 nmol/L) and 8 (11%) showed vitamin D deficiency (25-OHD < 25 nmol/L). Mean serum 25-OHD levels were lower in males (57.1±7.7 nmol/L) than in females (78.2±6.1 nmol/L), p = .01, even when controlled for age and season. Men were younger than the women (74.4±2.3 vs. 82.4±1.7, p = .005). Mean age was 78.7±1.5 years, and 33 (47%) were male.

Conclusions

Although vitamin D is rarely checked during delirium workup and/or management, high rates of hypovitaminosis D were found to be common in the delirium in-patients in whom it was checked. Larger studies would be needed to estimate the prevalence of hypovitaminosis D in delirium and whether hypovitaminosis D plays a role in the pathogenesis of delirium.