The Portal of Geriatrics Online Education

Family Medicine

Transitions of Care Workshop- Preparing 4th year Medical Students for Internship

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

Care Transitions are complicated and ineffective transitions result in poor patient outcomes and readmissions. The Association for American Medical Colleges (AAMC) has recently developed Entrustable Professional Activities (EPA) required for graduating medical students and two of the thirteen focus on transition of care issues. Residency programs are formalizing curricula around this topic as it is one of six focus areas within the Clinical Learning Environment Review (CLER) program, however graduating medical students have no formalized training in Care Transitions as of this time. This product provides a framework for practical training for graduating medical students and interns. A case based workshop on care transitions was created and utilized to instruct 4th yeard medical students and  Interns.  This included a small group didactic and a team based problem-solving session focused on a discharge case of a geriatric patient with multimorbidity. This curriculum was initially designed for medical students and interns on Internal Medicine, but can also be utilized to instruct learners in other fields and interprofessional learners.

Educational objectives: 
Define a care transition
Identify those at high risk for a complicated care transition
Apply specific risk assessment tools including the 8P’s, to estimate risk
Appraise the consequences resulting from ineffective transitions of care
Formulate a  safe care transition and discharge plan
Identify the important components of  successful transitional care
Additional information/Special implementation requirements or guidelines: 
Transitions of Care curriculum for 4th year medical students and Medical Interns
Interactive case based workshop to provide practical training on Transitions of Care
Small group classroom session with power point presentation and with a team based problem-solving component focusing on a discharge case of a geriatric patient with multimorbidit
Faculty Guide designed to guide active learning while students worked through the case in their teams
Publications from, presentations from, and/or citations to this product: 

Kranz, Kimberly, Strano-Paul, Lisa.  Preparing Graduating 4th year Medical Students for Internship- Implementing a Transitions of Care Workshop. Model Geriatric Programs: Geriatric Education Materials and Methods Swap. Presented at American Geriatric Society Annual Meeting Long Beach CA May 2016   

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. American Geriatric Society Annual Meeting, Long Beach CA, May 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Women in Medicine Research Day. Stony Brook School of Medicine, Stony Brook, NY March 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Clerkship Directors of Internal Medicine, Academic Internal Medicine Week, Atlanta, GA. October 2015.

                               

Date posted: 
Mon, 06/20/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/20/2016
Contact Person/Corresponding Author:



Suggested Citation:
Transitions of Care Workshop- Preparing 4th year Medical Students for Internship. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

Background: Dementia, delirium, and depression are core minimum competencies outlined by the AAMC (Association of American Medical Colleges) for medical students by graduation. Focus groups with Hopkins’ medical students found that they had variable clinical experiences with 3Ds during neurology and psychiatry rotations and found it challenging to take a history from a patient with cognitive impairment.
Methods: A joint curriculum was established with psychiatry and neurology core clerkship directors for third and fourth year medical students. Pre-session: PowerPoint with information on 3Ds, mini-cog, 4AT, and PHQ-9. Using pre-recorded simulated videos, students completed worksheets and discussed in class. Additionally we incorporated an in person caregiver interview. We assessed students’ knowledge with in-class audience response questions, pre and post evaluations on how well learning objectives were addressed, and three month post didactic to assess behavior change. This curriculum will be repeated 4 more times during 2015-2016 academic year.
Results: In the first 3 quarters, 64 students completed didactic. Students scored 44-78% correct on 3/6 knowledge test questions (other 3 questions scored >90% correct). Students demonstrated most improvement in use and interpret mini-cog for dementia screen and 4AT for delirium screen as well as communication skills with patients and caregivers. No self-reported change pre and post didactic for students’ ability to differentiating between dementia and depression, or between dementia and delirium. Most importantly, a majority of students identified the importance of communicating with caregivers and providing support not only for the patient, but also for the caregiver. At three months follow up survey (75% completion rate), students identified communication techniques and understanding caregiver’s challenges as the most useful “take home” points from didactic.
Conclusions: Overall the 3D didactic was well received by medical students. They improved in identifying when to use screening tools for 3Ds, which may translate from knowledge to behavior at their next rotations. They also overwhelmingly identified the importance of communicating and assessing caregivers’ needs. More data will be collected during additional sessions this academic year. This curriculum could be easily disseminated without much additional resources.

Educational objectives: 

Knowledge & Skills objectives:
1. Recognize, compare and contrast  delirium, dementia, and depression in various clinical presentations.
2. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression by evaluating video interviews among patient, caregiver, and provider triad communication skills.
3.  Assess an older patient with delirium, initiate a diagnostic work-up to determine the root cause (etiology), by identifying predisposing factors and differential diagnosis of delirium, by utilizing  non pharmacologic strategies for delirium.
4. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function by demonstrating the ability to differentiate the result of 4AT (rapid assessment test of delirium) based on video interview of delirious patient.  Proficiency to use Mini-Mental Status Exam (MMSE)and mini-cog to determine cognitive impairment.

Program/process Objectives:
• ≥ 95% of medical students in neurology and psychiatry rotation will attend the dementia day.
• Of students who attended didactic in person, 100% of the medical students will have demonstrated the ability to distinguish dementia, delirium, and depression using worksheets based on video interviews.

 

Publications from, presentations from, and/or citations to this product: 

AGS poster presentation 2016

AGS Educational Showcase 2016

Date posted: 
Tue, 07/26/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/26/2016
Contact Person/Corresponding Author:



Suggested Citation:
3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

Elder Care A Resource of Interprofessional Providers: Statin Therapy for Cardiovascular Risk Reduction in Older Adults

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Statin Therapy for Cardiovascular Risk Reduction in Older Adults is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Know the age upper age limit for use of the AHA/ACC 10-year cardiovascular risk calculator
  2. Avoid prescribing statins that may cross react with other medications
  3. Take appropriate action if a patient is thought to have statin-induced cognitive changes
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.    

Date posted: 
Mon, 04/25/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/05/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource of Interprofessional Providers: Statin Therapy for Cardiovascular Risk Reduction in Older Adults. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

Elder Care A Resource for Interprofessional Providers: Conducting Family Meetings

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Conducting Family Meetings is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings

Educational objectives: 
  1. Know when it is appropriate to conduct a family meeting
  2. Know the steps to follow when conducting a family meeting
  3. Be aware of statements to avoid during family meetings
Publications from, presentations from, and/or citations to this product: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Date posted: 
Tue, 07/05/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/05/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Conducting Family Meetings. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

Elder Care A Resource of Interprofessional Providers: Statin Therapy for Cardiovascular Risk Reduction in Older Adults

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Statin Therapy for Cardiovascular Risk Reduction in Older Adults is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Know the age upper age limit for use of the AHA/ACC 10-year cardiovascular risk calculator
  2. Avoid prescribing statins that may cross react with other medications
  3. Take appropriate action if a patient is thought to have statin-induced cognitive changes
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.    

Date posted: 
Tue, 03/28/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 03/28/2017
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource of Interprofessional Providers: Statin Therapy for Cardiovascular Risk Reduction in Older Adults. POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/201

Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Discussing Cognitive Aging with Patients and Families is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Define cognitive aging
  2. Explain the difference between fluid intelligence and crystalized intelligence
  3. Identify a clinical test that can be used to assess speed of medical processing
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.  

Date posted: 
Thu, 06/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

Medication Review Worksheet 2015

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition.1  Primary care providers seek tools to address polypharmacy.This medication review worksheet facilitates a targeted chart review, the development of an indication-matched medication list, and the use of available resources related to potentially inappropriate medications,3,4,5,6 common disease-specific guidelines,7,8,9,10 and helpful calculators11,12,13,14 to develop an evidence-based deprescribing plan for use in geriatric primary care patients.

1.  Fried, TR, O'Leary J, Towle V, et al.  Health outcomes assoicated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc, 62: 2261-2272, 2014.

2.  Anthierens S, Tansens A, Petrovic M, et al.  Qualitative insights into general practitioners views on polypharmacy.  BMC Family Practice, 11(65): 1-6, 2010.

3.  American Geriatrics Society 2015 Beers Criteria Update Expert Panel.  American Geriatrics Society 2015 Updated Beers criteria for potentially inappropriate medication use in older adults.  J Am Geriatr Soc, Epub ahead of print, 2015.

4.  Steinman MA, Beizer JL, DuBeau CE, et al.  How to use the American Geriatrics Society 2015 Beers criteria-a guide for patients, clinicians, health systems, and payors.  J Am Geriatr Soc, Epub ahead of print, 2015.

5.  Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures.  J Am Geriatr Soc, Epub ahead of print, 2015.

6.  O'Mahony D, O'Sullivan D, Byrne S, et al.  STOPP/START criteria for potentially inappropriate prescribing in odler people: version 2.  Age and Ageing, 0:1-6, 2014.

7.  James PA, Oparil S, Carter BL, et al.  2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8).  JAMA, 311(5): 507-20, 2014.

8.  Stone NJ, Robinson J, Lichtenstein AH, et al.  2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.  Circulation, 129(25 Suppl 2):S1-45, 2014.

9.  American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus.  Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update.  J Am Geriatr Soc, 61:2020-26, 2013.

10.  American Diabetes Association.  Standards of medical care in diabetes-2014.  Diabetes Care, 37(S1):14-80, 2014.

11.  Multiple creatinine clearance methods.  Global RPh.  Available http://www.globalrph.com/multiple_crcl_2012.htm

12.  Hwang C.  CHA2DS2-VASc score for atrial fibrillation stroke risk.  MD+Calc.  Available http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/

13.  Andrade, J.  HAS-BLED Score.  QxMD.  Available http://www.qxmd.com/calculate-online/cardiology/has-bled-score-bleeding-in-atrial-fibrillation

14.  2013 Prevention Guidelines Tools: CV Risk Calculator.  American Heart Association and American College of Cardiology.  Available at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

Educational objectives: 

This medication review worksheet will help trainees to:

1.  Complete a targeted chart review

2.  Reconcile a patient's medications by indication

3.  Develop an evidence-based strategy for deprescribing potentially inappropriate medications

Contact Person/Corresponding Author:



Suggested Citation:
Medication Review Worksheet 2015. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/201

Geriatric Fast Facts Quizzes

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

Geriatric Fast Facts (GFFs) [www.geriatricfastfacts.com] is a mobile enabled website which contains 1-2 page concise, peer-reviewed evidence-based educational summaries on key geriatrics topics to increase medical knowledge.

GFF Quizzes are quick, online assessment tools paired with GFF content, to be used by learners at the point of care to assess knowledge of geriatric content aligned with ACGME Milestones.  Design elements include quiz content searchable by topic, links to corresponding GFFs, MCQ/ short answer question formats and ability to include images. Learners enter brief demographic information to start (institution, email of self and up to 1 other) allowing annotated score results, displayed immediately after quiz completion, to be sent to themselves and one other individual (faculty, program director). These quick quizzes, available on hand held mobile devices at the point of care, linked to GFF content provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Educational objectives: 

The Geriatric Fast Fact (GFF) quizzes, available on hand held mobile devices at the point of care, linked to GFF content will provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Additional information/Special implementation requirements or guidelines: 

The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed and accessed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app".

Publications from, presentations from, and/or citations to this product: 

Quick Quizzes:  Geriatrics Right in Your Hand & at the Point of Care.  Denson K, Simpson D, Padua K, and the GET Collaboratives at the Medical College of Wisconsin & Aurora Health Care, American Geriatrics Society Annual Meeting, Baltimore, MD, 05/2015

Date posted: 
Thu, 10/08/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/08/2015
Product Viewing Instructions: 
The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app"
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Fast Facts Quizzes. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/201

"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

This two hour interprofessional curriculum brings together fourth year medical students and third year pharmacy students in a hands-on, interactive small group session. Learners are given a guide briefly describing the case and delineating five health care members and their roles and expertise in Mr. Moore's healthcare team (Mr. Moore's partner, the outpatient pharmacist, the inpatient intern, etc). A pair of interprofessional facilitators guide learners through the case, utilizing different healthcare team members' roles and expertise to explore methods of medication organization and systemic barriers to accurate and safe discharge medication reconciliation. Learners discover and discuss discrepancies in high-risk medications, gain an appreciation of systems hurdles for patients and healthcare providers during transitions of care, complete an exercise in writing discharge medication instructions, and brainstorm action items to personally employ to overcome systemic hurdles for safer discharge medication reconciliation.

Educational objectives: 

By the end of the two-hour session, learners will work collaboratively to:

  1. Describe the roles and expertise of three health professions that can collaborate to reconcile medications and enhance safety of medication orders at the time of hospital discharge. 
  2. List three potential communication barriers between health professionals involved in discharge planning that contribute to medication errors in vulnerable older adults.
  3. Identify key components of discharge medication lists and instructions to communicate information safely to patients, caregivers, primary care providers and others on the healthcare team.
Date posted: 
Tue, 08/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/201

Interprofessional Grand Rounds

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

The Rowan University School of Osteopathic Medicine, together with the Rutgers University School of Nursing, and Rutgers School of Health Related Professions, piloted an interactive, team-based “Interprofessional Grand Rounds” as an instructional strategy to promote interprofessional care plan development and enhance understanding of roles and responsibilities across disciplines.  A total of 235 nursing, physical therapy, respiratory therapy, and medical students collaborated in small groups to problem-solve a complex, multi-faceted case presented with video elements to facilitate gait analysis.  Students answered case study questions using an innovative scratch-off ticket technique.  A team of interdisciplinary faculty facilitated the case-based group discussions. 

Educational objectives: 
  • Explain the importance of effective team communication in a healthcare setting
  • Stimulate team skills in respectful communication and cooperation by creating collaborative interprofessional groups
  • Report increased knowledge of other health care professions and individual confidence in taking an active role as a member of an interprofessional team
Additional information/Special implementation requirements or guidelines: 

Students were seated in small groups of 5 to 7 students representing different health care professions.  This design created a collaborative atmosphere and allowed open communication among the students from all professions.

  • Chairs in clusters (no tables)
  • Mixture of team members from each health care profession
  • Typical team composition: 3 to 5 Medical Students, 1 Nursing student, 1 to 2  Physical Therapy students, and 1 Respiratory Therapy student
Date posted: 
Mon, 10/12/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/12/2015
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Grand Rounds. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/201

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