Issue

As the New Year starts, it is a good time for all physicians to consider what is necessary for our patients’ care in the months ahead. Early recognition of problems through healthcare screening and preventive strategies are key to maintaining health and maximizing function throughout life. Unfortunately, many patients still fail to have simple tests and screenings that have become the standard of care. Having a list of agreed-upon recommendations in a patient’s file makes it easier to keep track of what is necessary as the year progresses. There are many places to seek recommendations, and

Nanaging a geriatrics practice can be extremely gratifying—and extremely challenging. Older patients who need geriatrics care typically have complex and overlapping problems—not only medical problems but also functional, psychosocial, environmental, and financial problems. This makes providing care more time consuming and much more complicated. A coordinated team approach involving geriatricians, geriatric nurse practitioners, social workers, psychiatrists, and others is often needed.

Despite some promising changes in reimbursement for evaluation and management services provided by phys

Case Presentation
A 71-year-old man, Mr. K, returns to see his psychiatrist, Dr. P. Mr. K has come to the psychiatry clinic on and off for several years for treatment of dysthymia that has been managed primarily by behavioral interventions, as he has been reluctant to take psychiatric medications. He would often express distress with somatic symptoms and over the years has complained of chronic light-headedness. Extensive work-up of his symptoms has been negative in the past, and his medical history has been significant for hypertension alone.

Several months prior to the current visit with

Oversight of long-term care (LTC) prescribing is getting a little more difficult because, on top of the restrictions on access imposed on prescribers as a result of Medicare Part D, there are now additional pressures being applied by LTC state surveyors. These new surveyor pressures are the results of the revised survey guidelines concerning pharmacy services and unnecessary medications that were introduced on December 18, 2006. In addition to these factors, it appears likely that legislative changes planned for Medicare Part D may place even greater restrictions on prescribing.

The Need fo

Case Presentation
Mr. HD was an 86-year old man with a history of diabetes, hypertension, congestive heart failure, chronic kidney disease, and moderate dementia. He was admitted to the hospital from a subacute rehabilitation facility with three gangrenous toes on his right foot. Work-up at that time revealed a large arterial thrombus in the internal iliac artery extending to the femoral artery. At the time of hospitalization, the patient was delirious with episodes of lethargy and agitation. Mr. HD was evaluated by a vascular surgeon, who recommended an iliofemoral bypass procedure. As part

Introduction
Colorectal cancer (CRC) is the third most common type of cancer and second leading cause of cancer death in the United States.1 It primarily affects patients over 50 years of age. While the much publicized death of news anchor Katie Couric’s 42-year-old husband Jay Monahan spawned national interest in CRC screening,2 screening rates in this country remain at only approximately 50%.

Colorectal cancer almost always develops from precursor polyps. Further, colonoscopy with polypectomy can reduce the incidence of this largely preventable cancer by approximately 66%.3,4 In additi

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

January 2007

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 “Dementia Screening Tools for the Primary Care Physician,” which appears on pages 38-45 in this issue of Clinical Geriatrics.

Accreditation
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Med

Anticholinergic Therapy for OAB: Cognitive Implications for an At-Risk Geriatric Population
Gary G. Kay, PhD
Introduction