Preoperative Evaluation of the Elderly Surgical Patient

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.

Regulatory Issues on Behavioral and Psychological Symptoms of Dementia in the United States

The entity, behavioral and psychological symptoms of dementia (BPSD), is a useful concept in that it focuses attention on an aspect of dementia that has long been ignored in both research and treatment. Although it is useful as a broad category that includes a number of more specific clinical entities, BPSD is too broad a target to serve as an indication for a particular drug. Labeling with such a claim would be potentially misleading because it would not be clear what specific patient population would likely benefit from treatment.

Problems of generalization of findings. Regulatory attitudes

To approve a drug means to release it for use in a specific patient population which should be characterized as clearly as possible in the labelled indications in the Summary of Product Characteristics (eg patients with major depression according to DSM III-R).Ideally, the patient samples in various clinical trials should be representative of this specific patient population, and the crucial question is whether the study data allow an extrapolation to the wider patient population which we intend to treat.Basically, what is valid for preclinical data and animal exposure, should also be valid for humans: more or less all regulatory authorities agree that they should accept valid data and information from all regions and all clinical studies available in order to minimize unnecessary human exposures and needless duplication. This is especially important in therapeutic fields where there is an urgent need for treatment due to the lack of suitable alternatives.

Using a Group Workshop to Encourage Collaborative Learning in an Undergraduate Counseling Course

This article summarizes a collaborative learning project for an upper level undergraduate counseling course. Groups of students designed and presented a workshop on a therapeutic intervention for a specific patient population. Each student also wrote a paper on an individually selected topic. Examples of students' workshops, reactions to and evaluations of the assignment, and grading procedures are described. The assignment provides a model for the kind of collaborative work students may encounter in advanced study.