This article is the third in a three-part series. This series of articles addresses how health care organizations (ie, organized or integrated care systems or large provider groups that receive payment under either a capitated or fee-for-service basis) can improve the quality of transitions among care venues for patients with complex care needs. Part I provided an introduction and discussed strategies for ensuring accountability for patients in transition and facilitating the effective transfer of information. Part II focused on enhancing practitioners’ skills and support systems and enabling patients and caregivers to play a more active role in their transitions. Part III will address the need to align financial and structural incentives to improve patient flow across care venues, and will recommend steps organizations can take to initiate a quality improvement strategy for transitional care.

Pain that accompanies surgical procedures remains prevalent and is one of the aspects of anesthesia that generates the greatest concern for patients about to undergo surgery. Effective pain control in the perioperative period is not only humane, but can have a positive long-term impact on recovery. This article reviews the relevant neurobiology of pain, the basis for advocating an aggressive preemptive multimodal approach to acute pain therapy throughout the entire perioperative period. A growing body of outcome studies demonstrates the long-term efficacy of this approach. (Annals of Long-Term Care: Clinical Care and Aging 2004;12[11]: 18-24)

Key therapeutic goals for treating overactive bladder include reducing urinary symptoms, improving quality of life for patients, and reducing comorbidities. In the older patient, some special considerations are warranted after initial diagnosis and before determining treatment. Initial assessment should seek to exclude the possibility of reversible symptoms of urinary frequency and urge due to comorbid illness or concomitant medication. Once reversible causes have been excluded, treatment can be initiated based on the presenting symptomatology. Antimuscarinic agents, often with the concomitant use of behavioral therapies, form the mainstay of medical management of overactive bladder, regardless of age. However, when managing older patients with overactive bladder it is necessary to consider the tolerability and safety profile of any additional medication, particularly when considering that the patient may be on other drugs for comorbid conditions. (Annals of Long-Term Care: Clinical Ca