Issue

CASE PRESENTATION
Mrs. M is a 77-year-old married woman who was brought to the emergency room after her husband found her to be confused and diaphoretic. She has a prior history of a right middle cerebral artery stroke, with left hemiplegia 3 months ago. Mrs. M was diagnosed with depression while undergoing rehabilitation. She was able to regain ambulation with a walker and was discharged home 1 month ago. She has a history of hypertension, atrial fibrillation, osteoporosis, and gastroesophageal reflux disease (GERD). Her current medications include venlafaxine extended-release 150 mg daily

RS is a 75-year-old Caucasian man with essential hypertension and type 2 diabetes mellitus of 7 years duration. He denies diabetic complications and takes only glipizide and atenolol. Physical exam shows weight 218 pounds, height 70”, body mass index 31, blood pressure 152/82 mm Hg, and absent reflexes at the ankles. Patients such as RS, who represent a common office scenario, raise several important questions regarding appropriate treatment:

• What are the risk factors for atherosclerotic vascular disease (ASVD) in this patient?
• Could he already have subclinical disease?

Herpes zoster (HZ) affects millions of older adults annually worldwide and lowers quality of life in a substantial number of older individuals via acute and chronic pain or postherpetic neuralgia (PHN). Herpes zoster is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia and is spread in afferent peripheral nerves in the setting of age, disease, and drug-related decline in cellular immunity to VZV. This article reviews treatment strategies and recent research for the prevention and treatment of HZ and PHN. Pharmacotherapeutic strategies to reduce HZ pain include antiv

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit th

This continuing medical education activity is presented by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Community-Acquired Pneumonia in the Older Patient,” which appears on pages 39-45 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to p

As we start another calendar year, many individuals ponder what New Year’s resolutions they will try to keep for the coming year. Will they include noble goals such as trying to work toward world peace, or something more tangible to attain in their busy lives? Many wish for something they want that they hope will bring them either physical or emotional fulfillment. For me, I give thanks for what I DO NOT have, and I try to keep this as a theme every day of the year.

Remember the last time you had a muscle strain or common cold? How often you wished it would go away while “suffering”

We’re all hearing a lot right now about “pay for performance”—programs that offer physicians and other health care providers financial rewards for meeting certain quality or cost-effectiveness standards. Private insurers started introducing pay-for-performance (P4P) programs in the 1990s. These days, “P4P” is making headlines because efforts to introduce it into Medicare are rapidly gaining ground.

An array of policymakers and stakeholders, including The Centers for Medicare & Medicaid Services (CMS), Congress, nongovernmental organizations, and medical societies are involved.

CASE PRESENTATION
An 86-year-old woman presented to the emergency department complaining of left-sided flank pain that had awoken her from sleep earlier that morning. She rated the pain severity as 6 on a scale of 1 to 10, with radiation to the left groin and no relief on position change. She had no hematuria, dysuria, fever, or chills. Past medical history included a stroke at age 83, with no residual deficits, hypertension, atrial fibrillation, depression, and pacemaker for sick sinus syndrome. Her medications were warfarin 5 mg daily, digoxin 0.25 mg daily, fosinopril 10 mg daily, and mir