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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Worker impairment: issues beyond alcohol or drugs.

Problem: One of my older colleague's work is steadily declining, and sometimes her judgment seems "off," and she is easily distracted. Alcohol and drugs are most certainly not the problem nor is this a disability that is protected by the Americans with Disabilities Act, requiring accommodation. I want to help, but I'm not sure what to do.

Removing the feeding tube: a procedure with a contentious past.

When tragic circumstances force families to focus on an individual's right to refuse treatment, society is forced to reexamine its views on life and death; these circumstances may result in legal rulings and state statutes. During media coverage of high-profile cases, reporters frequently used distinct terms like "brain dead," "persistent vegetative state," and coma interchangeably, but they are clinically different. Today, most bioethicists believe the right to refuse treatment is legally and ethically settled, but decision-making in individual circumstances often may remain less clear and emotionally charged.

Aging in place: multiple options, multiple choices.

The transition from one's own home into institutional settings is often difficult for residents and families. Historically, dependent elders wishing to remain in their communities had few options. Seniors now have multiple aging-in-place options that support their significant lifestyle demands and allow them to live with other like-minded individuals.