Trauma in the workplace: grief counseling 101.

Trauma in the workplace can be precipitated by a number of tragedies, but death of an employee is the most common occurrence. Bereavement, mourning, and grief are common reactions. In most cases, people successfully cope with the death within two months, but some develop chronic grief, which is also referred to as complicated grief. Principles of grief counseling are outlined along with the need for employee training on trauma.

Medical apps worth having.

Medical applications (apps) for smart phones have grown in popularity, with minimal oversight by regulatory agencies. A few Web-based resources exist that evaluate apps using peer review or certification standards. Eight clinical apps are presented along with brief explanations of each. Many users believe apps improve patient care and clinical decision-making, but until additional research is conducted, these assertions remain untested assumptions.

Locating useful patient brochures and handouts.

Educational handouts are becoming routine in health care, helping promote health literacy in patients and their caregivers. To be effective, handouts must be tailored to various target audiences. This article discusses several Web sites that provide accurate information for conditions commonly seen in long-term care.

Psoriasis: issues far more serious than cosmetic.

Psoriasis-the most prevalent autoimmune disease in the United States-is a chronic, relapsing disease with variable clinical features and triggers that are both genetic and environmental. Psoriasis is an independent risk factor for mortality and is linked to numerous comorbidities, including cardiovascular disease, clinical depression, diabetes, cancer, Crohn's disease, hypertension, obesity, metabolic syndrome, liver disease, infections, dyslipidemia, and osteoporosis. While there is no cure, topical medications, phototherapy, traditional systemic agents, and biologics offer a wide array of options for management of symptoms. A combination of agents is frequently needed for moderate-to-severe cases, and positive long-term outcomes require medication adherence. Significant knowledge gaps exist on disease onset and progression along with a lack of comparative-effectiveness research on treatment regimens.

Thermal burns and scalds: clinical complications in the elderly.

Burns are categorized as superficial, superficial partial thickness, deep partial thickness, and full thickness. Superficial burns heal spontaneously; more serious burns require treatment. Elders are disproportionately affected, and advanced age is associated with poorer outcomes, partially because of thin skin and preexisting conditions. Clinical complications are common in elderly burn victims. Treatment's two stages, acute care and follow-up care, are discussed. Severe burns can result in significant scarring and painful contractures, and victims are at increased risk for depression and related psychiatric problems. The majority of elders suffering from severe burns are transferred to long-term care and rehabilitation facilities for follow-up care. Most burns are preventable, and burns occurring in long-term care facilities require investigation.

Delving into foot mechanics and related problems.

Foot problems are common in elders, stemming from age-related podiatric mechanical problems or disease-induced pathology. Common mechanical problems include hammertoe, arthritis, bunions, and metatarsalgia. Disease-induced conditions include onychomycosis, athlete's foot, plantar warts, gout, and diabetes. Treatment is case-specific and often involves multiple interventions, including lifestyle changes. Prevention and treatment strategies are presented. Patient education on proper foot care is effective.When patients are unable to reach or see their feet, staff assumes responsibility for foot care.

Telemedicine: sorting out the benefits and obstacles.

Telemedicine (TM)-providing health services and information via a telecommunications device to patients or colleagues separated by distance-holds the promise of improving access to care, diagnosis and assessment, patient monitoring, treatment adherence, and positive health outcomes. TM is still evolving, and numerous obstacles must be overcome before it reaches its full potential. Major obstacles include licensure and reimbursement issues along with the development of TM care standards. While many studies have addressed TM's effectiveness, findings, although positive, are tempered because of small sample size and other methodological problems. Successful TM is clinically driven where a need is first identified and then a TM solution fulfills that clinical need.

Helping those with hoarding behaviors.

Hoarding--the excessive acquisition of and failure to discard possessions, which preclude the appropriate use of living spaces--undermines safety and health by increasing risk for fire, falls, and infections. Hoarding does not result from deprivation early in life, nor are elders with hoarding behaviors merely "thrifty or frugal." Up to 64% of elders with hoarding behaviors have self-care deficits. Comorbid depression, anxiety, alcohol dependence, physical trauma, and damage to the prefrontal and orbitofrontal cortex are common. Hoarding was historically viewed as a variant of obsessive-compulsive disorder (OCD), but compulsive hoarding is a symptom in just 24% of all OCDs. Approximately half of elders with hoarding behaviors suffer from psychiatric conditions, mostly major depression and mood disorders. Treating elders with hoarding behavior in a medical-psychiatric model is a complex matter that may include prescription medication if an underlying condition contributes to the problem. Hoarding behavior results in placement in a nursing facility when squalor poses a health or safety issue.

Put your right hip in, put your right hip out.

Hip replacement is one of the most common surgical procedures in the United States. Among the multiple reasons that joints degenerate, arthritis leads as a cause of hip pain and failure. Currently, most artificial joints wear out after 10 to 20 years, potentially necessitating another surgery. Total hip arthroplasty (or total hip replacement) involves replacing the femoral neck and femoral head. Devices are held in place using either cement, cementless, or hybrid procedures. Although it occurs in fewer than 1% of procedures, infection can be devastating and lead to the need for multiple surgeries. Today, several options are available when hip replacement is needed. Minimally invasive surgery (MIS) employs the same procedures and materials used in conventional hip surgery but results in less soft-tissue dissection. MIS anterior-hip arthroplasty is a variant of MIS that shortens recovery time. Hip resurfacing spares the femoral head and is generally viewed as a more complicated procedure that may be more appropriate for younger, more active patients. Computed-assisted surgery may allow better positioning of the acetabular component of the prosthesis. Two developing issues related to devices used for hip replacement are device recall and device registries.

Treating obesity in older adults: different risks, different goals, different strategies.

Almost 70% of adults 60 years of age and older are overweight according to the National Health and Nutrition Examination Survey 2005-2006. While being overweight is linked to numerous comorbidities and functional impairment, few studies have addressed obesity in elders, and even fewer have addressed sarcopenic obesity. Elder obesity requires different strategies, partly because most approved weight-reduction agents and/or surgical interventions are contraindicated in older adults. Strategies and objectives for weight loss are discussed along with the consultant pharmacist's role.

Telomeres: unlocking the mystery of cell division and aging.

Telomeres are DNA sequences that cap the ends of chromosomes, protecting them from fraying and fusing together during replication. During replication, telomeres lose some of their genetic material but are repaired by the ribonucleoprotein telomerase. Both telomeres and telomerase are linked to cell senescence and apoptosis, and research suggests they play key roles in aging, cancer, hereditary syndromes, and chronic diseases. Several theories of aging are reviewed along with the potential impact of telomerase in developing new treatments.

Tiptoeing around gait disorders: multiple presentations, many causes.

Walking appears to be a simple innate ability, but it is an extraordinarily complex process involving three major afferent systems (visual, proprioception, and vestibular). Humans' unique gait is established around age seven. Velocity and step-length change with age, but the overall package we call "gait" remains stable. Age is the single most important factor in changing gait, with some normal changes expected. Gait disorders, beyond what are normal age-related changes, are common among elders. At 60 years of age, 15% of elders have gait problems, increasing to 82% for those 85 years of age and older. Abnormal gait movement can be broadly defined as hyperkinetic (too much movement) and hypokinetic (too little movement). Gait disorders are classified into lowest level (affecting one afferent system), middle level (more afferent system involvement), and highest level (characterized by planning deficits) disorders. Gait disturbances may be a manifestation of underlying conditions or may be drug-induced. To treat gait disorders appropriately, clinicians must review the patient's disease progression, medication status, and environmental conditions. Physical therapy, medication changes, and, rarely, surgery can help improve gait.

Coping successfully with aging.

Aging is associated with physical decline, often accompanied by pathology and disability that can cause unhappiness and dissatisfaction. Despite this, many elders report a high level of satisfaction. This article discusses the anxiety associated with aging that some people experience, highlights research findings and models of aging, and pays particular attention to how elders compensate and cope with loss. Long-term care practitioners can help residents deflect negative stereotypes and improve their own attitudes about aging.

Mitochondrial disease: when the powerhouse goes awry.

Knowledge of and interest in mitochondrial disease is relatively recent. The first diagnosis of a mitochondrial cytopathy occurred in 1962. Since then, researchers have elucidated hundreds of types of mutant mitochondrial DNA and mapped their repercussions. This article walks the reader through the basics of mitochondrial function--normal and mutant. Mitochondrial cytopathies appear first in organs with high-energy needs; once a threshold of mutant mitochondrial DNA is exceeded, manifestations can be single or multisystem conditions. Although these conditions are currently incurable, some therapies aimed at enhancing mitochondrial function or scavenging free radicals may help individual patients. Certain nonpharmacological therapies should be employed in all patients. Research findings suggest that mitochondrial functioning may have a greater role in other pathologies than previously assumed.