Signal Transduction Processes Involved in Endothelin-Mediated Responses

CRC Press eBooks · 2024

• Cell biology
• Neuroscience
• Biology

Endothelin isopeptides mediate their biological responses by binding to specific cell surface receptors that have been identified on a variety of tissues and cells. 1–5 Binding of the endothelin isopeptides to cell surface receptors results in the generation of a number of second messengers such as cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), inositol phosphates, intracellular calcium, diacylglycerol, and arachidonic acid. These second messengers activate enzymes, such as kinases and phosphatases, which in turn phosphorylate or dephosphorylate key cellular proteins, leading ultimately to biological responses. The coupling of endothelin receptors to the effector molecules occurs through a family of GTP-(guanosine trisphosphate) binding proteins called guanine nucleotide regulatory proteins or G-proteins. G-proteins are heterotrimers consisting of α, β, and γ subunits. 6 The α subunits bind guanine nucleotides, whereas the βγ complex functions as a single unit. As many as 20 different a subunits, at least 4 β subunits, and 6 γ subunits exist, and their genes have been identified. 7 Binding of the endothelin isopeptides to the endothelin receptors occurs on the external surface of the cell membrane and promotes the interaction between the receptors and G-proteins on the intracellular surface of the membrane. This interaction promotes the dissociation of bound guanosine diphosphate (GDP) from The α subunit of the G-proteins and stimulates association of GTP to The α subunit. This subsequently results in the dissociation of The α subunit from the βγ complex, and the dissociated α-GTP subunit modulates the activity of the effector molecules. The α subunit has also been shown to display endogenous GTPase activity whereby bound GTP is hydrolyzed, resulting in inactivation of the cycle. Recent studies indicate that, in addition to being involved in the regulation of a subunit function, the βγ complex is also involved in the direct modulation of effector systems, such as adenylate cyclase, 8 phospholipase C, 9 , 10 phospholipase A2, 11 K+ potassium channels 12 as well as the membrane association of β-adrenergic receptor kinase. 13

DEVELOPMENT OF A TRAINING MODEL WITHIN HOSPICE AND PALLIATIVE CARE FOR NURSE PRACTITIONERS

Innovation in Aging · 2024-12-01

Abstract Workforce shortages within palliative care restricts availability of this service. Although clinicians may develop an interest in this specialty later in their careers, acquiring the necessary education and training is challenging. In academic medical centers like the Veteran’s Administration (VA), interprofessional palliative care teams are well-positioned to deliver high-quality, accessible palliative care services when patient needs surpass what can be addressed by primary care and surgical subspecialities. Given workforce shortages, this quality improvement project aims to increase competency for nurse practitioners (NPs) in hospice and palliative care. A 12-month, minimum 500 clinical hour, training program designed to provide clinical and skill-based education to NPs currently working on the VA Community Living Center was developed. The predominantly practical curriculum focuses on interprofessional teamwork, communication skills, and application of medical, psychosocial, cultural, spiritual, and ethical content. The curriculum is designed in a longitudinal manner that supports the NP’s ability to maintain their routine clinical care responsibilities. The program includes two hours of protected time each day consisting of hospice and palliative care clinical experiences alongside interprofessional learning. The training cohort, beginning March 2024, consists of two NPs. The team developed a mixed methods approach to assess competencies and progress across the training period. This project has resulted in an innovative approach to enhance hospice and palliative care training that will advance mid-career clinicians’ skills and help address workforce shortages without requiring clinicians to leave their jobs for extended training. Implementation will have implications for the feasibility, sustainability, and replication of this model.

Sexual and gender minority <scp>health‐related</scp> content in geriatric fellowships

Journal of the American Geriatrics Society · 2023 · 5 citations

• Medicine
• Family medicine
• Medical education

INTRODUCTION: Despite a growing number of older lesbian, gay, bisexual transgender, and queer (LGBTQ) adults in the United States, education on care for this vulnerable population has historically been inadequate across all levels of training. This research assessed the extent of LGBTQ education in geriatric medicine fellowship curricula across the United States. METHODS: We designed a survey to anonymously collect information from geriatric medicine fellowship programs on LGBTQ curricular content. Eligible participants included all 160 fellowship directors on record with the American Geriatrics Society. The survey addressed demographics of the fellowship program, current state of inclusion of LGBTQ content in didactic curricula and in clinical settings, and other available training opportunities. RESULTS: Out of those contacted, 80 (50%) completed the survey. Of the programs surveyed, 60 (75%) were housed in internal medicine, 19 (24%) were in family medicine, and one was in their own department. Forty-seven fellowships (59%) reported some formal didactic session (e.g., lecture or case based), with the majority of these programs (72%) featuring 1-2 h of formal instruction. Forty-five programs (56%) reported offering no formal clinical experiences. There was less than 50% coverage for all surveyed topics in the required curriculum (range 46% for discrimination to 9% for gender affirming care). Time and lack of expertise were cited as the main barriers to content inclusion. CONCLUSIONS: Curricular content regarding care for LGBTQ older adults is inadequate in geriatric medicine fellowships. Faculty development of current educators and providing standardized guidelines and curricula are steps toward addressing this deficit.

Learning to Lead: Reflections from the Tideswell‐AGS‐ADGAP Emerging Leaders in Aging Program Scholars

Journal of the American Geriatrics Society · 2019-01-03 · 4 citations

The Tideswell Emerging Leaders in Aging (ELIA) Program is a 1-year leadership training program focused on developing a sustainable pipeline of leaders in aging who are poised to lead initiatives that will optimize the health of older people. The Tideswell ELIA Program is jointly administered by the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, and Tideswell at University of California, San Francisco (UCSF), a program within the Division of Geriatrics at UCSF. The ELIA Program prepares early to midcareer healthcare professionals in aging (scholars) for their transition into key leadership roles that involve one or more areas of patient care, education, and research. The program emphasizes the understanding of one's own and others' inherent work strategies and communication styles as integral to leading programs. Approximately 15 ELIA scholars are selected annually to participate in this interactive leadership development program. We conducted a qualitative analysis of program evaluations from 2015 to 2018 scholars (n = 47) to determine effectiveness and impact. All scholars (100%) completed the end-of-training survey. Scholars' satisfaction with the program is high. Scholars reported heightened leadership development and improvements in leadership skills, including communication, team building, and self-awareness. Scholars also reported enhancement of personal leadership attributes that contributed to career advancement. The Tideswell ELIA Program accelerates scholars' personal career development, positively impacts their institutions, and ultimately benefits older people. Sustaining leadership programs such as the Tideswell ELIA Program is vital to ensure a continuous pipeline of leaders skilled in both advocating for and advancing the health of older Americans. J Am Geriatr Soc 67:434-436, 2019.

Assessing Resident Attitudes and Confidence after Integrating Geriatric Education Into a Primary Care Resident Clinic

The American Journal of Medicine · 2018-03-09 · 8 citations

Preoperative Assessment in Older Adults: A Comprehensive Approach.

PubMed · 2018-08-15 · 22 citations

Surgical outcomes are significantly influenced by patients' overall health, function, and life expectancy. A comprehensive geriatric preoperative assessment of older adults requires expanding beyond an organ-based or disease-based assessment. At a preoperative visit, it is important to establish the patient's goals and preferences, and to determine whether the risks and benefits of surgery match these goals and preferences. These discussions should cover the possibility of resuscitation and ventilator support, prolonged rehabilitation, and loss of independence. The assessment should include evaluation of medical comorbidities, cognitive function, decision-making capacity, functional status, fall risk, frailty, nutritional status, and potentially inappropriate medication use. Problems identified in any of these key areas are associated with an increased risk of postoperative complications, institutionalization, functional decline, and, in some cases, mortality. If a patient elects to proceed with surgery, the risks should be communicated to surgical teams to allow for inpatient interventions that lower the risk of postoperative complications and functional decline, such as early mobilization and limiting medications that can cause delirium. Alcohol abuse and smoking are associated with increased rates of postoperative complications, and physicians should discuss cessation with patients before surgery. Physicians should also assess patients' social support systems because they are a critical component of discharge planning in this population and have been shown to predict 30-day postoperative morbidity.

Deprescribing: A simple method for reducing polypharmacy.

PubMed · 2017-07-01 · 42 citations

Polypharmacy brings with it increased risks for adverse drug events and reduced functional capacity. This 4-step plan will help you safely deprescribe in older adults.

Effect of Medical Student Perception of Older Adults: A Two Year Experience

Open Access Journal of Gerontology & Geriatric Medicine · 2017-09-12

Open Access Journal of Gerontology & Geriatric Medicine is a specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults and the disease related to studying physical

Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings

Journal of Education and Training Studies · 2016-08-31

Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals of care and medication management in both in-hospital and non-hospital settings. Residents rotated through both in-hospital and non-hospital settings as one block rotation. They took a test of geriatric learning before the rotation and then took the same test at the end of the rotation. Residents showed an improvement in several geriatric domains on completion of a combined in-hospital and non-hospital rotation curriculum. We concluded that the development and implementation of a combined rotation curriculum has practical application to resident learning and the potential to improve geriatrics care outside of hospital settings.