A great deal has happened since the start of the Medicare Part D program, resulting in a whole host of new issues and questions that we will address and answer on an ongoing basis. We also encourage you to submit questions so that we can address concerns and issues in the pages of the journal for everyone’s benefit.

Discussing a patient’s prognosis is a significant challenge for many clinicians. This conversation is particularly challenging with patients who have chronic illnesses other than cancer, whose prognosis is especially difficult to estimate. As a result, clinicians are often uncertain when they should discuss end-of-life care options, and how they should help patients and their families plan for the future. This article will review existing data to help clinicians estimate prognosis in chronic illness. In particular, we will focus on heart failure, dementia, cancer, and chronic obstructive pulmonary disease. Practical strategies are suggested to help clinicians initiate and structure discussions about prognosis. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[2]:18-23)

Urinary incontinence is a prevalent health problem among residents in long-term care, with significant costs and morbidity. The U.S. Centers for Medicare & Medicaid Services (CMS) recently reinterpreted the federal regulation for the assessment and management of urinary incontinence in long-term care (F-315). This CMS document is used by both federal and state survey agencies to examine the quality of urinary continence care provided to residents. This article presents an overview of key aspects of the revised regulation, and it provides updated clinical algorithms for the effective management of urinary incontinence in long-term care consistent with the new interpretive guidance. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[2]:30-37)