The elderly brain is more vulnerable to the adverse effects of surgery and anesthesia compared with the younger brain. Both anecdotally and in clinical investigation, the elderly surgical population has been found to exhibit a significantly higher prevalence of postoperative cognitive decline. The most common manifestations of this decline are postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).
The critical importance of weight management and smoking cessation in OSA treatment are emphasized, and the roles of other health behaviors, oral appliances, and pharmacologic and surgical treatments in OSA are addressed.
Participants will learn about the pitfalls in the diagnosis of migraine, including aids to differentiating between episodic and chronic headache disorders
Chronic Constipation and Constipation-Predominant Irritable Bowel Syndrome: Fostering a Patient-Centric Model of Care
The goal of this continuing education activity is to enhance competency and build additional skills among internists in the treatment and management of IBS-C and CC, ultimately improving outcomes for those who suffer from these conditions.
This activity has been designed to meet the educational needs of primary-care physicians, physician assistants, and nurse practitioners who treat patients with substance use disorder. It explores the safe use of opioids in the treatment of pain . To minimize the risk of abuse and addiction, evidence-based prescribing practices must be used when treating acute and chronic pain with opioids.
This CME, CNE and ACPE accredited activity will help improve your knowledge of the treatment of diabetes mellitus and improve the quality of care for older adult patients in the long-term care setting. The activity includes two separate modules delivered in a slide and video format. The videos feature examples of patient case vignettes with real-life examples of unique issues that affect the older adult patient. The first module discusses the management of diabetic patients with cognitive issues and the second focused on the advantages and disadvantages of pharmacological treatment. This education is brought to you by Boston Medical Center's Endocrinology and Geriatric Care departments.
Updates on the Diagnosis and Management of Alzheimer's Disease: Screening, Imaging, and Emerging Treatment Strategies
Alzheimer's disease is the most common form of dementia, affecting approximately 6% to 7% of the population over 65 years of age. The multifactorial etiology of Alzheimer's disease involves complex interplay among genetic, biochemical, and physiologic factors, which manifest clinically as a range of progressive cognitive, affective, and behavioral symptoms. Despite its prevalence and significant associated medical, psychosocial, and economic burden, Alzheimer's disease often remains undiagnosed and untreated. In particular, studies have shown that rates of diagnosis in primary care are well below epidemiologic estimates. Primary care providers (PCPs) may incorrectly believe that diagnosing dementia early is not important, and instead may feel that it can be harmful to patients and their families.
This accredited activity will focus on providing an increased awareness of Non-24-Hour Disorder, and consensus recommendations for diagnosis and treatment. Two leading experts in circadian rhythm disorders will review the data, symptomatology, and treatment of this disease occurrence in the totally blind population. Presenters will provide an overview of the master body clock, and the concept of a 24- versus a non-24-hour day as a foundation for understanding the epidemiology and clinical presentation of patients with Non-24-Hour Disorder.
This is a 30-minute webcast. This review highlights the presence of critical gaps in current knowledge about Alzheimer's disease and the progression of cognitive impairment.
Of all the newly diagnosed bladder cancer patients, 25%-30% of them will have muscle-invasive disease that ideally will require major surgery in the form of a radical cystectomy, bilateral pelvic lymphadenectomy and creation of a urinary diversion as an integral part of curative therapy.
Neurologists are faced with many challenges in caring for patients with Parkinson's disease (PD). This chronic, long-term illness that affects at least one million people in the United States requires a coordinated healthcare partnership between the physician and the patient. The importance of early diagnosis is essential to delaying disease progression and early diagnosis and intervention may be aided by recent advances in biomarkers, genomics, and imaging.
Primary care providers are increasingly called upon to manage gout, a once less common disease that is becoming more prevalent and difficult to treat as our society rapidly ages. Gout is also on the rise and increasingly severe due to the increasing prevalence of obesity as well as animal fats and high fructose corn syrup in the Western diet.
"Why don't patients just do what we say?!!" Motivational Interviewing is a clinical method for helping people to resolve ambivalence and make successful behavior change by evoking motivation and commitment. In this voice-over slides interactive course you will acquire specific, tailored skills to have brief and effective interactions with patients. You will learn to recognize patient Change Talk, analyze self-assessed style in barriers to patient behavior change, and give personalized feedback and clinical recommendations in effective manner.
Many factors have been identified as predictive of acute pain becoming chronic. Unfortunately, the number of factors and the lack of consistent algorithms make the prediction and prevention of chronic pain difficult. A patient-centered approach to developing a risk profile for a patient in acute pain can decrease the likelihood of this patient developing chronic pain and experiencing its associated consequences. Specific examples are reviewed from each relevant domain or perspective of this approach.
From the July 2013 issue of The Clinical Advisor: Workplace stress and career burnout among clinicians. A shrinking pool of providers coupled with the extension of coverage to millions of previously uninsured individuals may increase practitioner anxiety.
The Role of the NP in Caring for the Patient with Coronary Artery Disease (CAD) (Pharmacology Credit) - EXPIRED
This activity will discuss the nurse practitioner's role in managing coronary artery disease (CAD), including the goals of medical management, new pharmacotherapies available for treatment, strategies to improve treatment adherence, and common pitfalls to avoid when managing CAD in primary care patients. Recent clinical trials will also be discussed and case studies will be presented.
This activity presents a series of discussions on the clinical management of psoriasis and psoriatic arthritis from our expert faculty. Video vignettes depicting patient-clinician interactions in four separate case presentations are used to illustrate evidence-based best practices for diagnosing and treating patients with psoriasis and psoriatic arthritis. Disease management in the context of comorbid conditions is also discussed. The cases include a man with genital psoriasis and psoriatic arthritis; a woman of child-bearing age with severe scalp psoriasis; a woman with plaque psoriasis on the elbows, knees, and scalp who previously had cervical cancer; and a man with coronary artery disease who has palmoplantar psoriasis.
Chronic Pain: Communication and Evaluation Tools to Optimize Outcomes. A 76-Year-Old Woman with Persistent Knee Pain - EXPIRED
Osteoarthritis (OA) is among the more common sources of chronic pain. Risk factors for OA include age >50 years and obesity. Accordingly, OA prevalence is increasing. As you'll learn in this case, evidence-based guidelines recommend both therapeutic lifestyle changes and medical management to alleviate the diminished function and loss of quality of life associated with the chronic pain of OA.
Postmenopausal Osteoporosis, defined as a bone mineral density (BMD) T-score of ≤ -2.5 at the total hip, femoral neck, or lumbar spine, is a serious problem that predisposes women to increased bone fragility and fracture risk. BMD screening should be considered based on the woman's risk profile, and is recommended for all women aged ≥ 65years. However, screening rates vary widely, and family physicians may lack a rationale for BMD testing. Thus Postmenopausal Osteopososis often remains undiagnosed until a fracture occurs.
Ask the Expert: Personalized Approaches to Sustained Biologic Remission in Crohn's Disease - EXPIRED
Crohn's disease is a chronic, inflammatory disorder that can become disabling over time. Because it is a lifelong disease, the importance of maintaining symptomatic control and remission is critical to minimizing short- and long-term complications and improving outcomes and quality of life for patients
Meeting Diagnostic Challenges in Alzheimer's Disease: A 59-Year-Old Woman Exhibiting Recent Memory Impairment at Work and Home
Changes in cognitive function can reflect a number of conditions, including but certainly not limited, to the mild cognitive impairment that precedes the dementia phase of Alzheimer's disease. In this case, a woman who has exhibited some concerning cognitive lapses in her professional and family life undergoes evaluation to identify the probable pathology underlying these developments.
Diverticular disease is one of the most prevalent medical conditions in the United States. Symptomatic diverticular disease comprises a spectrum ranging from mildly symptomatic, with a profile similar to irritable bowel syndrome, to acute bouts of diverticulitis with complications such as abscess or perforation.
Practical Solutions to Critical Topics in the Management of Chronic Pain: From Bench to Bedside - EXPIRED
Chronic pain is a significant public health problem in the United States that is both common and costly. A significant barrier to the optimal diagnosis and treatment of chronic pain is a lack of knowledge regarding the underlying causes of chronic pain and the optimal use of analgesic compounds. This activity uses an interactive format to update clinicians on the pathophysiology of chronic pain and the mechanisms of action of common classes of analgesic therapies.
Cardiovascular disease (CVD) is the leading cause of death in the United States, primarily due to the effects of heart disease and stroke. The goal of this activity is to educate primary care clinicians on the evidence-based treatment of heart failure and provide guidance for commonly encountered clinical dilemmas.
As members of the Baby Boomer generation enter their 60s, it is reasonable to anticipate that clinicians will face an increase in the number of older patients with inflammatory bowel disease (IBD). Older patients with IBD can be a particular challenge for the practicing clinician, because they often present such issues as extensive differential diagnoses, comorbidities, polypharmacy, and poor patient adherence.
Neurogenic Overactive Bladder: Assessment and Management Strategies to Optimize Patient Outcomes - EXPIRED
Neurogenic overactive bladder (OAB) is a chronic and distressing medical condition that has profound physical, emotional, and financial ramifications for patients and is commonly seen in patients with neurologic conditions such as multiple sclerosis, spinal cord injury, cerebral vascular accident, Parkinson's disease, and diabetes mellitus.
Identify lifestyle changes that a person who has high titers of antinuclear antibodies but no lupus-specific symptoms should make.
Current Controversies in the Identification and Management of Cancer-Related Pain: A Case-Based Approach - EXPIRED
The heterogeneous nature of cancer pain can present challenges for the oncologist as well as for primary care providers, who often care for patients who are in remission but still have lingering cancer or cancer treatment related pain. This activity uses an online, case-based approach to discuss strategies for the optimal management of cancer pain for both the oncologist and primary care clinician.
Case 3: An 80-Year-Old Woman with Atrial Fibrillation and Multiple Cardiovascular Risk Factors - EXPIRED
In older patients with multiple comorbidities, high risk for stroke, and risk factors for bleeding, nonadherence to anticoagulation therapy is particularly important. With warfarin, INR values may signal poor adherence. With the newer anticoagulation options, assessing adherence may be difficult because of the inability to precisely assess their level of anticoagulation.
A 53-year-old man with type 2 diabetes presents to his internist with erectile dysfunction, increased appetite, and blurry vision. At his last visit 6 months ago, his LDL-C was borderline high.
This course discusses establishing a diagnosis and matching appropriate procedure to diagnosis. Curative vs palliative and acute vs chronic back pain are described and delineated.
This is part II of a three-part series of case-based articles on optimal, evidence-based approaches to the management of gout, an inflammatory arthritis that over the past two decades has doubled in prevalence in the United States. Here, management approaches are outlined for a patient with stage 3 chronic kidney disease and hypertension. He presents with an acute gout flare—an occurrence that is becoming more frequent.
This course describes various types of primary headache disorders and differentiates between migraine headache and other kinds of headache disorders. The presentation details diagnosis, acute treatment, and prophylactic measures that can reduce pain in patients who experience migraine headaches.
Major depression is a highly debilitating illnesses associated with significant morbidity, impairments in occupational and social functioning and increased risk of suicide. Patients typically have some degree of symptomatic response to treatment, but often suffer from persisting residual symptoms that cause significant functional impairment, decreased quality of life, and increased risk of relapse.
Extensive evidence demonstrates the analgesic efficacy of adjuvants, anti-inflammatories, and simple analgesics. The use of these classes of medications for chronic pain using rational polypharmacy may allow sparing of the use of opiods, but new studies question the safety of certain nonopiods. Therefore, knowledge of the pharmacology of nonpiods is important to ensure that analgesic treatment decisions are based on the best available information.
Clinicians face many challenges when diagnosing and managing patients with ulcerative colitis and Crohn's disease, known collectively as inflammatory bowel disease (IBD).
This program focuses on managing urinary incontinence in older women. Participants will learn how to name the type of urinary incontinence associated with detrusor overactivity and identify interventions for overflow incontinence.
This program focuses on managing diabetic ketoacidosis in adults. Objectives are being able to describe what happens when glucagon is released in the liver, identify the most common stressor in patients with a hyperglycemic crisis and understanding the role of fluid resuscitation in managing diabetic ketoacidosis.