Site Index - Geriatrics

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Alzheimer's Disease

Recognizing apathy in Alzheimer's disease

Apathy has been increasingly recognized as a neuropsychiatric symptom in many neurologic disorders. Since apathy per se almost never occurs as an isolated syndrome, it must be viewed in the context of an individual's entire behavioral and cognitive status.

Clinical Pharmacology

CME: Antidepressants: cornerstone of treatment, but beware of side effects

Depression

CME: Antidepressants: cornerstone of treatment, but beware of side effects

Interpersonal psychotherapy for depression

Interpersonal psychotherapy (IPT) is a time-limited, evidence based psychosocial intervention used to treat depression either alone or in combination with medication.

Expect psychiatric side effects from corticosteroid use in the elderly

Psychiatric side effects are extremely common in patients treated with corticosteroids. The elderly and those with previous psychiatric diagnoses are not at increased risk for these side effects, but women and those with prior corticosteroid-induced psychiatric side effects are.

Derm DDx

Case: Rapidly enlarging lesion on the wrist

Consider keratoacanthoma in rapidly enlarging tumors occurring after minor skin trauma.

Case: Asymptomatic, slowly enlarging facial lesion

Consider sebaceous tumors such as sebaceous epithelioma in yellow lesions on the face

Derm diagnosis: Ulcerated papule on vertex of the scalp

Consider radiation dermatitis in a non-healing ulceration at the site of previous X-ray therapy

Derm diagnosis: Asymptomatic eruption of the face of a 68-year-old woman

Differential diagnosis of puritic eruption on the face

Derm DDx: Chronic rash on the neck

Localized cluster with itching, burning, relieved by scratching

DERM DDx: Intractable generalized pruritus in an 82-year-old

Papules on trunk, axillary vaults, and buttocks

Pruritic eruption on the leg: Follows excision of a benign lesion

A 53-year-old woman presents with a 4-day history of a pruritic eruption on her leg. She had a benign lesion surgically excised with 2-layer suture closure 1 week before onset of the eruption.

DERM DDX

Bumps on the legs: More prominent at day's end, shrink overnight

DERM DDx

Itchy eruption on the legs

Family Medicine

Guidelines and the older patient

American College of Physicians Annual Meeting, April 19-21, 2007, San Diego, Calif

Geriatrics

Parkinson's Disease (American College of Physicians PIER)

CME

No effect of statin on cardiovascular outcomes in older patients with advanced systolic heart failure

In older patients with advanced systolic heart failure of ischemic etiology, rosuvastatin added to standard heart failure medication had no significant effect on the incidence of cardiovascular death, nonfatal MI, and nonfatal stroke compared with placebo.

Even asymptomatic PAD significantly increases the risk of mortality in older patients

All older adults should be screening for peripheral arterial disease.

Effective strategies to identify postmenopausal women at risk of osteoporosis

CME activity

EDITORIAL: How I became a lifelong learner: Going the distance in Geriatrics.

"I'm still learning." - Michelangelo (1475-1564)

Initiating aspirin/dipyridamole once daily can improve adherence

American Heart Association's International Stroke Conference 2007, February 7-9, 2007, San Francisco

The Geriatric Patient

CME activity

Internal Medicine

CME: Antidepressants: cornerstone of treatment, but beware of side effects

Guidelines and the older patient

American College of Physicians Annual Meeting, April 19-21, 2007, San Diego, Calif

Meeting Highlights: Atypical stroke symptoms more common in women

American Heart Association's International Stroke Conference 2007, February 7-9, 2007, San Francisco

Medicare matters

Medicare Q & A: Is it true that the practice of a participating Medicare physician is not allowed to divorce a Medicare patient?

A Medicare patient can be divorced from a practice the same way that non-Medicare patients are divorced.

Medicare Q & A: Should office staff be using a modifier on the medication administration code to avoid having Medicare routinely deny the charge for the nurse's injection of medications when it is billed with an office visit?

To ensure getting paid for a nurse's injection of a medication when it is billed with an office visit, be sure to list the appropriate CPT or HCPCS (J code) for the drug on the claim.

Medicare Q & A: Isn't a physician allowed to bill Medicare under the physician's number when a nurse practitioner employed by the physician provides services at a hospital?

Medicare's rules are clear that a physician isn't allowed to bill incident-to in the hospital or in any place of service other than the office.

Medicare Q & A: Is it lawful to not collect co-pay or to forgive deductibles when patients are suffering financially?

It is within the Medicare rules to forgive or waive the co-insurance and/or deductible in situations where a financial hardship exists, as long as it's not a routine practice for all Medicare patients.

Medicare Q & A: If a Medicare patient comes in for a motor vehicle accident and while there the patient's diabetes is treated due to high blood sugar and other chronic conditions, is it billed?

If a Medicare patient is treated both for a motor vehicle accident and a separate condition such as diabetes, file separate office visits on separate claims, one to the auto insurance carrier and one to Medicare for the diabetes.

Q&A: Is referring physician's name required on a Medicare claim?

Not all services require a referring physician's name on a Medicare claim.

Q&A: Will Medicare pay for consultations over the phone?

With one exception, Medicare doesn't pay for consultations over the phone.

Q&A: Can administration of local anesthetic be billed separately?

Medicare bundles the local anesthetic and its administration into the procedure.

Q&A: When can a nurse practitioner bill Medicare for consultations?

A nurse practitioner can bill Medicare for consultations, but must do it under his or her own number within a group.

Psychiatry & Behavioral Health

CME: Antidepressants: cornerstone of treatment, but beware of side effects

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CME SHOWCASE

Pediatric Asthma Management: Bridging the Gaps Between Knowledge and Practice (CME)

Controlling Esophageal Disease in Children...Beyond the Acid (CME)

Optimizing Medical Therapy for Patients With Non-Hodgkin Lymphoma: A Case-Based Approach: CE Teleconference Archive 2 of 2 (CME)

The Past, Present, and Future of Anticoagulation Therapy (CME)

The Diabetes Dilemma: Combating An American Health Crisis (CME)

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