An 82-year-old man with chronic coronary syndrome reports exertional chest pressure 3 to 4 times per week despite aspirin, atorvastatin, and lisinopril. He has a history of sinus node dysfunction with a resting heart rate of 52 beats/min, first-degree AV block, hypertension, and recurrent lightheadedness when standing. His seated blood pressure is 118/66 mm Hg and standing blood pressure is 96/58 mm Hg. He does not have heart failure. Which antianginal medication is the most appropriate to add for symptom control?
An 82-year-old woman is brought to clinic by her daughter because of 2 weeks of increasing confusion and difficulty managing her daily activities. She has also had constipation, dry mouth, blurry vision, and trouble starting her urine stream. Her medication list includes diphenhydramine at bedtime for sleep, oxybutynin for overactive bladder, and amitriptyline for neuropathic pain. Urinalysis is negative for infection, and no focal neurologic deficits are present. Which of the following is the most likely explanation for her symptoms?
A health system reviews 12 months of data for patients age 75 years and older who were readmitted within 30 days of hospital discharge. Excess readmissions occur primarily among patients transferred to skilled nursing facilities after insulin or anticoagulant regimens were changed. Review of these cases identifies discrepancies between discharge orders and facility medication records and delayed follow-up of the changed high-risk medications. Which intervention most directly addresses the identified system failure?
