Issue
CASE PRESENTATION
Mr. D is a 62-year-old white male who was brought to the emergency room (ER) by the police after his sister called to report that he was in violation of an order of protection. When the police arrived, Mr. D was found lying on the living room floor, appearing pale, diaphoretic, and intoxicated. Ms. R, his sister, reported to the police that he suffers from diabetes and hypertension. Mr. D has a prior history of alcohol dependence with multiple hospitalizations for detoxification. Ms. R gained custody of his three daughters, ages 7, 9, and 10 years, more than 5 years ago dueCASE PRESENTATION
A 67-year-old bedridden African-American female was brought to the emergency room (ER) by her husband with the acute onset of altered mental status changes and urinary incontinence. From her history it was revealed that 1 week prior to this episode she had been evaluated by the Neurology service as an outpatient for possibly having had syncopal episodes over the previous several months. An electroencephalogram (EEG) done during that visit showed cortical instability with intermittent slowing in both hemispheres, and transient sharp waves consistent with a cerebral infarctionINTRODUCTION
Influenza, a lower respiratory tract infection caused by influenza viruses infecting ciliated cells, is associated with up to 300,000 hospitalizations annually in the United States.1 The disease occurs in epidemics in both hemispheres during winter months, but summertime outbreaks do exist.2 Persons with chronic illness and those in long-term care (LTC) settings are at increased risk for complications, including secondary pneumonia.3 Influenza and pneumonia consistently rank as a leading cause of death, of which about 90% of victims are over 64 yeACCREDITATION
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 inOctober 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 Secondary Stroke Prevention—Part II,” which appears on pages 35-44 in this issue of Clinical Geriatrics.
ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for ContWe must not underestimate the importance of having someone available to advocate for an elderly individual’s “best interests.” While personal wishes must be honored, not all older people can express what they truly want done or not done (depending on their unique circumstances). “Living wills” can go a long way to clarify one’s prior wishes, but even here there may be room for interpretation.
Two distinct cases recently brought this issue close to me, each illustrating different aspects of the same issue.
Mrs. B is an 82-year-old widow who lived alone and remained independe
More than 1.5 million Americans are injured every year by drug errors in various settings, including nursing homes. The Institute of Medicine (IOM), in its most recent report, evaluated medication errors in a broad range of settings, and finding tremendous room for improvement.1 In the report, the IOM states that at least one-quarter of all medication-related injuries are preventable. Gurwitz et al2,3estimated that 800,000 preventable medication-related injuries occur annually in nursing homes across the country.
Most of the “medication errors” in long-term care (
