Background Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME. Methods We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations. Results We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions. Conclusions There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.

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Objective: To determine the associations of delirium with urinary tract infection (UTI) and asymptomatic bacteriuria (AB) in individuals aged 65 and older.Methods: The protocol for this systematic review and meta-analysis was published on PROSPERO (CRD42020164341). Electronic databases were searched for relevant studies, professional associations and experts in the field were additionally contacted. Studies with control groups reporting associations between delirium and UTI as well as delirium and AB in older adults were included. The random effects model meta-analysis was conducted using odds ratios (ORs) with 95% confidence intervals (CIs) as effect size measures. The Newcastle-Ottawa scale was used to rate the studies' quality. Heterogeneity was assessed using the Q and I 2 tests. The effects of potential moderators were investigated by both subgroup and meta-regression analyses. The risk of publication bias was evaluated using the funnel plot and Egger's test.Results: Twenty nine relevant studies (16,618 participants) examining the association between delirium and UTI in older adults were identified. The association between delirium and UTI was found to be significant (OR 2.67; 95% CI 2.12-3.36; p < 0.001) and persisted regardless of potential confounders. The association between delirium and AB in older adults in the only eligible study found (192 participants) was insignificant (OR 1.62; 95% CI 0.57-4.65; p = 0.37). All included studies were of moderate quality. Conclusion:The results of this study support the association between delirium and UTI in older adults. Insufficient evidence was found to conclude on an association between delirium and AB in this age group. These findings are limited due to the moderate quality of the included studies and a lack of available research on the association between delirium and AB. Future studies should use the highest quality approaches for defining both delirium and UTI and consider AB in their investigations.

Background and Objectives:To provide an updated review article studying the applicability and effectiveness of sensor networks in measuring and supporting activities of daily living (ADLs) among non-demented older adults. Research Design and Methods: Systematic review following PRISMA guidelines. Systematic search of PubMed, Embase, PsycINFO, INSPEC, and the Cochrane Library, from October 26, 2012 to January 3, 2018 for empirical studies, measuring and supporting ADLs among independently living, non-demented older adults, investigating wireless sensor monitoring networks. Results:The search queries yielded 10,782 hits of which 162 articles were manually reviewed. Following exclusion criteria, 13 relevant articles were retained. Although various types of sensor networks with different analyzing algorithms were proposed, from simple video monitoring to complex sensor networks distributed throughout a house, all articles supported the use of wireless sensors for identifying changes in activity patterns. Discussion and Implications: Wireless sensor networks appear to be developing into an effective solution for measuring ADLs and for identifying changes in their patterns. They offer a promising solution to support older adults living independently at home. However, there is too much focus on technology, and practical usefulness still needs to be further elaborated. Sensors should focus on ADLs that are sensitive to the earliest signs of cognitive decline, as well as quantitative markers, such as errors in the execution of ADLs.

BACKGROUND/OBJECTIVES: The diagnostic process in a university memory clinic is based largely on cognitive testing. However, input from informants, acquired through interview or questionnaires, may significantly impact diagnosis. We sought to evaluate whether informant questionnaires for basic and instrumental activities of daily living, or for identifying progressive cognitive decline would improve diagnostic predictability of neurodegenerative disorders compared with either the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery or the Mini-Mental State Examination score alone. DESIGN: Retrospective data analysis using logit models. SETTING: University hospital outpatient memory clinic. PARTICIPANTS: A total of 394 patients with dementia, mild cognitive impairment (MCI), depression, or subjective cognitive impairment were assessed. MEASUREMENTS: Bristol Activities of Daily Living Scale, Functional Activities Questionnaire, Informant Questionnaire on Cognitive Decline in the Elderly, and the Physical Self-Maintenance Scale questionnaires were obtained. Analyses through logit models were performed to predict outcome diagnoses, based on cognitive scores alone or in combination with one or more informant questionnaires. RESULTS: The four questionnaires were highly correlated (.31-.86). The addition of informant questionnaires improved diagnostic predictability between differential diagnoses of MCI and dementia, or dementia and depression. However, the misprediction rate was reduced by up to 6 percentage points only. Adding more than one questionnaire or all CERAD subtests instead of their sum score never improved prediction in regularized logit models to a clinically relevant extent. CONCLUSION: Although questionnaires contribute to a statistically better prediction of the outcome diagnosis, for some sets of differential diagnoses, the benefit may not be clinically pertinent when routine semistructured informant interviews are used by trained personnel. However, standardized assessment, particularly when patients are seen longitudinally, should not be underestimated.