Issue

CASE PRESENTATION
Ms. C, the Director of Volunteer Services at a community hospital, receives a call from a nurse about one of her volunteers, Mrs. S. The nurse explains that the staff is concerned about Mrs. S, who is a 72-year-old widowed retired nurse. Mrs. S has been a volunteer at the hospital for many years, and following the death of her husband the previous year, she has been coming in almost every day. The nurse explains that Mrs. S often stays quite late into the evening, and has started asking if she can sleep there at night. Mrs. S is performing her volunteer services quite well,

INTRODUCTION
Radiation-induced1,2 second primary malignant tumors include meningiomas, sarcomas, and gliomas. Patients who received prophylactic intracranial irradiation and intrathecal methotrexate for acute lymphocytic leukemia or lymphoma may occasionally also develop brain tumors. Such tumors consist mainly of glioma. Rarely, meningioma, meningeal melanocytoma, fibrosarcoma, and primitive neuroectodermal tumor have also been described.1,3 We report herein an interesting case of primary central nervous system (CNS) lymphoma developing 8 years after irradiation for ca

This is the second of a two-part article that examines the effects of terrorism on the elderly. Part I reviewed the medical complications caused by biologic, nuclear, chemical, and bombing attacks. This article focuses on the practical issues of resilience and the identification of those elderly persons who are prone to developing psychiatric disorders following a terrorist attack. The three most commonly occurring psychiatric disorders following such an attack—posttraumatic stress disorder (PTSD), acute stress disorder, and depression—are reviewed. Special note is made of areas where thes

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 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in th

Although everyone recognizes that there are a growing number of older individuals and a need for physicians to be skilled in the special needs and problems of the elderly, little has been done to ensure that medical trainees receive comprehensive training in this regard. As a program director of an Internal Medicine residency program, I make sure on a regular basis that my program meets all of the ever-changing rules and regulations. The American Board of Internal Medicine (ABIM) requires that

“Residents must have formal instruction and assigned clinical experience in geriatric medicine.

September 2006

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 “Antiplatelet Therapy and Stroke Prevention and Treatment—Part I,” which appears on pages 36-45 in this issue of Clinical Geriatrics.

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council fo

The current system for determining compensation for physicians who care for Medicare beneficiaries clearly needs fixing. Clinicians, organizations such as the American Geriatrics Society (AGS), federal agencies such as the Centers for Medicare & Medicaid Services (CMS), and many of the nation’s legislators are in agreement on this point. Exactly what constitutes the right fix, however, is at issue. So is older Americans’ access to quality care.

Over the course of the summer, federal agencies and several lawmakers have proposed a variety of changes to the Medicare physician fee schedule

Imagine a physician diagnosing a frail senior patient with hypercholesterolemia, but instead of writing a prescription for the most appropriate statin for that specific patient, the physician is forced to give a list of all available treatment options—and let the patient make a decision on his or her own. Of course, no one knowledgeable about the healthcare system would ever allow this situation to develop. This decision would be too difficult for any patient to make, let alone a nursing home resident suffering some level of dementia, yet this is the situation that the Centers for Medicare &