Managing patients on antipsychotics: your domain, too.

Primary care physicians are increasingly likely to care for patients taking antipsychotics. Here's what you need to know about the common adverse effects, major risks, and monitoring required.

Public health and medical education: a natural alliance for a new regional medical school.

A century ago, the Flexner Report challenged U.S. medical schools to critically evaluate their curricula in order to nurture physicians equipped to meet the needs of an evolving society. Recently, medical educators have been charged to increase the emphasis on prevention, care of populations, public health, and community medicine. The Commonwealth Medical College (TCMC) is a new MD-granting medical school inspired by and founded in response to a community need. The founders' vision was to recruit and train physicians to fill workforce needs in Northeast Pennsylvania. In its first few years, TCMC embarked on two major public health initiatives, the Regional Health Assessment and the Community Health Research Projects (CHRPs). The results of the health assessment have been used to guide TCMC's curricular development and research agenda. The CHRPs foster commitment to community involvement, regional engagement, and participatory research. TCMC partners with various organizations and community physicians to ensure that students learn (1) to apply knowledge and skills acquired through the course of their studies to public health research in varied settings; (2) the fundamentals of community engagement, collaboration, and service-based practice; and (3) to address the different needs of patient subgroups and populations. These programs provide opportunities for students to be active participants in community capacity building while achieving specific competencies in public health. Existing partnerships with community organizations are enhanced, strengthening the regional focus of the school. This model of incorporating public health into medical education can potentially be replicated in other institutions in the U.S. and internationally.

Evaluation of suspected dementia.

As the proportion of persons in the United States older than 65 years increases, the prevalence of dementia will increase as well. Risk factors for dementia include age, family history of dementia, apolipoprotein E4 genotype, cardiovascular comorbidities, chronic anticholinergic use, and lower educational level. Patient history, physical examination, functional assessment, cognitive testing, laboratory studies, and imaging studies are used to assess a patient with suspected dementia. A two-visit approach is time-effective for primary care physicians in a busy outpatient setting. During the first visit, the physician should administer a screening test such as the verbal fluency test, the Mini-Cognitive Assessment Instrument, or the Sweet 16. These tests have high sensitivity and specificity for detecting dementia, and can be completed in as little as 60 seconds. If the screening test result is abnormal or clinical suspicion of another disease is present, appropriate laboratory and imaging tests should be ordered, and the patient should return for additional cognitive testing. A second visit should include a Mini-Mental State Examination, Geriatric Depression Scale, and verbal fluency and clock drawing tests, if not previously completed.

When to stop screening: a review of breast, gynecologic, and colorectal cancer screening in women over age 65.

Because age alone is not an indicator of health, there is no clear consensus among the various cancer screening guidelines on when to stop cancer screening. For breast, cervical, and colorectal cancer, there are recommended screening tests, while, for other gynecologic cancers, there are not. When discussing with older women patients when to stop cancer screening, we encourage practitioners to review the goals of the screening test, assess the health and functional status of the patient, and discuss her values and health goals. To facilitate this discussion, we review proposed frameworks for determining when to screen older patients for cancer. We also review the concepts of "well" and "frail" older adults. Finally, we review the current screening recommendations for breast, gynecological, and colorectal cancers, and the reasoning behind them, from the United States Preventative Screening Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the American Geriatric Society.

Students who participate in a student-run free health clinic need education about access to care issues.

We surveyed first-year medical students about preparedness for work at student-run clinics, and for addressing patients' access to care, and social issues. Most students did not know how to get uninsured patients ongoing care or medications outside of the student-run clinic. A large majority of students desired an orientation addressing these issues.