Barbara Messinger-Rapport - Academia.edu (original) (raw)

Papers by Barbara Messinger-Rapport

Cleveland Clinic journal of medicine, 2015

Journal of the American Medical Directors Association, 2015

This is the ninth yearly update on clinical care in the nursing home. Topics covered this year ar... more This is the ninth yearly update on clinical care in the nursing home. Topics covered this year are disease management in frail elders, heart failure, pneumonia, mild cognitive impairment, meaningful activities in the nursing home, atrial fibrillation, and anticoagulation.

Cleveland Clinic journal of medicine, 2015

This paper discusses recent developments and recommendations for elderly patients concerning immu... more This paper discusses recent developments and recommendations for elderly patients concerning immunizations, heart failure, lipid therapy, blood pressure control, and dementia.

Journal of the American Medical Directors Association, 2015

Medical students report that they receive inadequate training in different levels of care, includ... more Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. MedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. The program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. Five to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. The program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. With institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. Between October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%-58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.

Geriatrics

Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the i... more Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the incidence of fracture is higher in women than in men. Risk factors for osteoporotic fractures in postmenopausal women include family history of bone fracture, ethnicity, and weight < 127 pounds. Densitometry is used to diagnose osteoporosis and can be performed at intervals to monitor bone density during treatment. The older woman's diet should, in general, include 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D. Estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and exogenous parathyroid hormone are pharmacologic therapy options that can preserve and increase bone mass and reduce the risk of fracture.

Cutis; cutaneous medicine for the practitioner

... Unusual Presentation of a Squamous Cell Carcinoma. Auteur(s) / Author(s). SINCERELY (1) ;AGAR... more ... Unusual Presentation of a Squamous Cell Carcinoma. Auteur(s) / Author(s). SINCERELY (1) ;AGARWAL Shikhar (1) ; MOODLEY Jayavani (1) ; HOSCHAR Aaron P. (1) ; MESSINGER-RAPPORT Barbara J. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...

Geriatrics

As women live longer and anticipate good health during their later years, cancer screening become... more As women live longer and anticipate good health during their later years, cancer screening becomes increasingly complex. Physicians receive discordant recommendations from medical societies, task forces, Medicare, and special interest groups about which cancers merit screening, how screening should be performed, the frequency of screening, and when screening should be discontinued. Female patients may receive confusing recommendations from their friends, the lay press, the Internet, and their own doctors. Given the proliferation of opinions and the limited data regarding the efficacy of cancer screening in older women, physicians must help their patients understand the potential benefits, limitations, and consequences of various cancer screenings for each individual woman.

Cleveland Clinic journal of medicine, 2015

American journal of Alzheimer's disease and other dementias, Jan 7, 2014

The incidence of neurocognitive disorders, which may impair the ability of older adults to perfor... more The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and res...

Clinics in geriatric medicine, 2006

The increasingly large proportion of elderly women in the United States population carries a disp... more The increasingly large proportion of elderly women in the United States population carries a disproportionate burden of breast cancer. The advent of minimally invasive surgical techniques applicable to breast disease has brought new opportunities to diagnose and treat breast cancer in the older population. This article reviews issues important to the evolving field of breast cancer management in older women: cancer risk and screening considerations, diagnosis and biopsy approaches, and surgical treatment options based on current studies and recommendations.

Geriatrics, 2003

By anticipating issues of mobility, physicians can help older women lead more independent and sat... more By anticipating issues of mobility, physicians can help older women lead more independent and satisfying lives. Osteoarthritis is a major cause of physical disability in older women. Aerobic exercise, resistance training, and judicious analgesic use can be well-tolerated interventions that reduce pain and disability. Reducing the risk of injurious falls is paramount given the prevalence of osteoporosis. Interventions that may reduce fall risk include minimizing the use of sedative-hypnotic agents, providing training in transfer skills (balance and gait training), and adapting the home environment.

Clinics in geriatric medicine, 2002

Cardiovascular disease leads to significant morbidity and mortality in the older population. Resu... more Cardiovascular disease leads to significant morbidity and mortality in the older population. Results of risk reduction can be dramatic in terms of patient survival and quality of life. This article reviews evidence for cardiovascular risk factors and disease prevention in older adults. Interventions which reduce morbidity and mortality from coronary artery disease, heart failure, and cerebrovascular disease in the elderly population are examined. Attention is given to the role of cardiovascular disease in older women and in minorities, subsets not well-represented in many studies.

Geriatrics, 2002

American women are more likely to die from cardiovascular disease than from any other cause. Alth... more American women are more likely to die from cardiovascular disease than from any other cause. Although hypertension is most prevalent, most deaths are attributed to coronary heart disease. Heart disease in women manifests approximately 12 to 15 years later than in men, up until menopause. Then the severity of coronary artery lesions in women accelerates until it equals or surpasses that of men by the late 70s or early 80s. Physicians can help older women reduce their risk for heart disease and stroke by managing hypertension and hypercholesterolemia and providing beta-blocker treatment when indicated after MI. Nonpharmacologic interventions may be effective as well. New guidelines for aspirin help identify women under age 80 who would benefit most from antiplatelet therapy.

Clinics in Geriatric Medicine, 2002

Cleveland Clinic journal of medicine, 2009

Behavioral problems are common in dementia and may reduce the quality of life of the patient and ... more Behavioral problems are common in dementia and may reduce the quality of life of the patient and disrupt the home life of family members. Families want a pill that can cure the myriad phenotypes of a decaying brain; unfortunately, there is no pharmaceutical silver bullet. This paper reviews the evidence for using different classes of drugs for the behavior symptoms commonly encountered in dementia, focusing on concerns that the primary care physician would have about using these drugs.

Journal of the American Medical Directors Association, 2014

This is the eighth yearly update on clinical care in the nursing home. Topics covered this year a... more This is the eighth yearly update on clinical care in the nursing home. Topics covered this year are heart failure, delirium, nutrition, hospice, diabetes mellitus, frailty, and sarcopenia.

Clinical Reviews in Bone and Mineral Metabolism, 2005

The risk of injurious falls increases with age. In women younger than 75 yr, much of the attentio... more The risk of injurious falls increases with age. In women younger than 75 yr, much of the attention toward reducing the risk of injurious falls is appropriately directed at identifying and treating osteoporosis. In the oldest women, however, particularly those over 75 to 80 yr of age, strategies must be multifaceted. The prevalence of medical conditions and geriatric syndromes increases with age. Effective interventions to reduce the risk of injurious falls include optimizing medical conditions, assessing geriatric syndromes, addressing pain, improving balance, and reducing polypharmacy. In this article we offer an evidence-based approach to identifying and treating fall risks in the oldest women.

Cleveland Clinic journal of medicine, 2015

About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fra... more About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fractures, traumatic brain injury, and even death. Therefore, it is important to identify older adults at risk and recommend helpful interventions.

Cleveland Clinic journal of medicine, 2015

Journal of the American Medical Directors Association, 2015

This is the ninth yearly update on clinical care in the nursing home. Topics covered this year ar... more This is the ninth yearly update on clinical care in the nursing home. Topics covered this year are disease management in frail elders, heart failure, pneumonia, mild cognitive impairment, meaningful activities in the nursing home, atrial fibrillation, and anticoagulation.

Cleveland Clinic journal of medicine, 2015

This paper discusses recent developments and recommendations for elderly patients concerning immu... more This paper discusses recent developments and recommendations for elderly patients concerning immunizations, heart failure, lipid therapy, blood pressure control, and dementia.

Journal of the American Medical Directors Association, 2015

Medical students report that they receive inadequate training in different levels of care, includ... more Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. MedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. The program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. Five to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. The program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. With institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. Between October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%-58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.

Geriatrics

Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the i... more Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the incidence of fracture is higher in women than in men. Risk factors for osteoporotic fractures in postmenopausal women include family history of bone fracture, ethnicity, and weight < 127 pounds. Densitometry is used to diagnose osteoporosis and can be performed at intervals to monitor bone density during treatment. The older woman's diet should, in general, include 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D. Estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and exogenous parathyroid hormone are pharmacologic therapy options that can preserve and increase bone mass and reduce the risk of fracture.

Cutis; cutaneous medicine for the practitioner

... Unusual Presentation of a Squamous Cell Carcinoma. Auteur(s) / Author(s). SINCERELY (1) ;AGAR... more ... Unusual Presentation of a Squamous Cell Carcinoma. Auteur(s) / Author(s). SINCERELY (1) ;AGARWAL Shikhar (1) ; MOODLEY Jayavani (1) ; HOSCHAR Aaron P. (1) ; MESSINGER-RAPPORT Barbara J. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...

Geriatrics

As women live longer and anticipate good health during their later years, cancer screening become... more As women live longer and anticipate good health during their later years, cancer screening becomes increasingly complex. Physicians receive discordant recommendations from medical societies, task forces, Medicare, and special interest groups about which cancers merit screening, how screening should be performed, the frequency of screening, and when screening should be discontinued. Female patients may receive confusing recommendations from their friends, the lay press, the Internet, and their own doctors. Given the proliferation of opinions and the limited data regarding the efficacy of cancer screening in older women, physicians must help their patients understand the potential benefits, limitations, and consequences of various cancer screenings for each individual woman.

Cleveland Clinic journal of medicine, 2015

American journal of Alzheimer's disease and other dementias, Jan 7, 2014

The incidence of neurocognitive disorders, which may impair the ability of older adults to perfor... more The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and res...

Clinics in geriatric medicine, 2006

The increasingly large proportion of elderly women in the United States population carries a disp... more The increasingly large proportion of elderly women in the United States population carries a disproportionate burden of breast cancer. The advent of minimally invasive surgical techniques applicable to breast disease has brought new opportunities to diagnose and treat breast cancer in the older population. This article reviews issues important to the evolving field of breast cancer management in older women: cancer risk and screening considerations, diagnosis and biopsy approaches, and surgical treatment options based on current studies and recommendations.

Geriatrics, 2003

By anticipating issues of mobility, physicians can help older women lead more independent and sat... more By anticipating issues of mobility, physicians can help older women lead more independent and satisfying lives. Osteoarthritis is a major cause of physical disability in older women. Aerobic exercise, resistance training, and judicious analgesic use can be well-tolerated interventions that reduce pain and disability. Reducing the risk of injurious falls is paramount given the prevalence of osteoporosis. Interventions that may reduce fall risk include minimizing the use of sedative-hypnotic agents, providing training in transfer skills (balance and gait training), and adapting the home environment.

Clinics in geriatric medicine, 2002

Cardiovascular disease leads to significant morbidity and mortality in the older population. Resu... more Cardiovascular disease leads to significant morbidity and mortality in the older population. Results of risk reduction can be dramatic in terms of patient survival and quality of life. This article reviews evidence for cardiovascular risk factors and disease prevention in older adults. Interventions which reduce morbidity and mortality from coronary artery disease, heart failure, and cerebrovascular disease in the elderly population are examined. Attention is given to the role of cardiovascular disease in older women and in minorities, subsets not well-represented in many studies.

Geriatrics, 2002

American women are more likely to die from cardiovascular disease than from any other cause. Alth... more American women are more likely to die from cardiovascular disease than from any other cause. Although hypertension is most prevalent, most deaths are attributed to coronary heart disease. Heart disease in women manifests approximately 12 to 15 years later than in men, up until menopause. Then the severity of coronary artery lesions in women accelerates until it equals or surpasses that of men by the late 70s or early 80s. Physicians can help older women reduce their risk for heart disease and stroke by managing hypertension and hypercholesterolemia and providing beta-blocker treatment when indicated after MI. Nonpharmacologic interventions may be effective as well. New guidelines for aspirin help identify women under age 80 who would benefit most from antiplatelet therapy.

Clinics in Geriatric Medicine, 2002

Cleveland Clinic journal of medicine, 2009

Behavioral problems are common in dementia and may reduce the quality of life of the patient and ... more Behavioral problems are common in dementia and may reduce the quality of life of the patient and disrupt the home life of family members. Families want a pill that can cure the myriad phenotypes of a decaying brain; unfortunately, there is no pharmaceutical silver bullet. This paper reviews the evidence for using different classes of drugs for the behavior symptoms commonly encountered in dementia, focusing on concerns that the primary care physician would have about using these drugs.

Journal of the American Medical Directors Association, 2014

This is the eighth yearly update on clinical care in the nursing home. Topics covered this year a... more This is the eighth yearly update on clinical care in the nursing home. Topics covered this year are heart failure, delirium, nutrition, hospice, diabetes mellitus, frailty, and sarcopenia.

Clinical Reviews in Bone and Mineral Metabolism, 2005

The risk of injurious falls increases with age. In women younger than 75 yr, much of the attentio... more The risk of injurious falls increases with age. In women younger than 75 yr, much of the attention toward reducing the risk of injurious falls is appropriately directed at identifying and treating osteoporosis. In the oldest women, however, particularly those over 75 to 80 yr of age, strategies must be multifaceted. The prevalence of medical conditions and geriatric syndromes increases with age. Effective interventions to reduce the risk of injurious falls include optimizing medical conditions, assessing geriatric syndromes, addressing pain, improving balance, and reducing polypharmacy. In this article we offer an evidence-based approach to identifying and treating fall risks in the oldest women.

Cleveland Clinic journal of medicine, 2015

About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fra... more About one-third of community-dwelling adults age 65 and older fall each year, and some suffer fractures, traumatic brain injury, and even death. Therefore, it is important to identify older adults at risk and recommend helpful interventions.