Panic disorder is characterized by current and unexpected panic attacks accompanied by persistent concern about future attacks and maladaptive behavioral changes. Cognitive-behavioral models propose that panic symptoms are maintained through catastrophic misinterpretations of benign bodily sensations, which trigger escalating anxiety and avoidance behaviors. This case study describes the assessment, cognitive-behavioral formulation, intervention, and clinical evolution of a 31-year-old woman presenting with recurrent panic attacks, anticipatory anxiety, and significant distress related to parenting responsibilities. The client sought psychological support following a severe panic episode that occurred in a public setting and was followed by persistent anxiety, repeated emergency department visits, and fear of experiencing further attacks. Assessment procedures included a clinical interview, the Mini-Mult, and the Beck Anxiety Inventory (BAI). Findings suggested elevated emotional tension and vulnerability to anxiety, with no evidence of severe psychopathology. A cognitive-behavioral formulation highlighted the interaction between childhood adversity, family vulnerability to anxiety, health-related stressors, parental responsibility, catastrophic interpretations of bodily sensations, and safety behaviors. The intervention consisted of nine individual cognitive-behavioral therapy sessions focused on psychoeducation, breathing training, cognitive restructuring, reduction of safety behaviors, and gradual confrontation of previously avoided situations. Over the course of treatment, the client demonstrated a significant reduction in panic-related distress, increased tolerance of anxiety symptoms, decreased avoidance, and improved perceived self-efficacy. Residual vulnerability remained in situation involving concerns about her children’s health and period of increased parental burden. This case illustrates the usefulness of cognitive-behavioral interventions for panic disorder and highlights the importance of considering parenting-related stress and personal developmental experiences when conceptualizing and treating anxiety disorders.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare immune mediated disorder of the peripheral nervous system which can occur at any age but is more common in older males. Clinical features can include weakness, sensory loss, and gait impairment which may lead to significant functional loss and difficulty managing ADLs and IADLs independently in the elderly population. This case report will highlight why primary care providers need to be aware of CIDP.

Background: This study is a secondary analysis of the process of telephone follow-up of communitydwelling older people with chronic heart disease after index hospitalization. Objective: The objectives of the study were to understand the common problems encountered and the interventions provided by telephone, using the Omaha System as a framework.

Methods: The intervention nurse conducted assessments and interventions based on the system. Patient problems were categorized according to the system. Thirty-four sets of audio recordings, with a total of 896 minutes of verbatim from 17 participants, were transcribed and analyzed.

Results: The results identified the 5 most frequent problems and described the interventions most frequently prescribed by the intervention nurse. Circulation was the only physiological problem among the top problems identified. Nutrition, medication regime, physical activity and healthcare supervision were the common healthrelated behavioral problems cited at the initial and final call. Surveillance was the most frequent category of intervention, followed by teaching, guidance and counseling as the second most frequent category of intervention provided to the participants in the study.

Conclusions: A better understanding is needed of the process of care provided by the intervention nurse via telephone to older people with chronic heart disease in the community. The body of knowledge can extend the continuum of care provided to people living with chronic heart disease in the community. Further study on the integration of low and high technology would enhance the health surveillance and counseling of older people with chronic heart disease

Background: Mobility disability due to spinal stenosis is common in the senior population. We assessed the recovery timeline and compared outcomes among seniors undergoing spinal stenosis surgery by type of surgery.

Methods: We investigated 451 patients (77.4 ± 10.9 years, 58% women) of a consecutive cohort prior to spinal stenosis surgery and at 3 or 6-month and at 12-month follow-up. At each visit, pain, neurological dysfunction, and disability were assessed using the North American Spine Society questionnaire. Repeatedmeasures analysis compared outcomes by type of surgery adjusting for baseline symptoms, gender, age, comorbidities, center, and year of surgery.

Results: Most improvement occurred within the first 3 to 6 months with little or no improvement up to 12 months. Over 12 months and in adjusted models, patients receiving one-segment versus multi-segment decompression experienced greater reduction of pain (-46.0% vs. -41.0%; p = 0.05), neurological dysfunction (-36.4% vs. -26.1%; p < 0.001), and disability (-30.5% vs.-26.7%; p = 0.06). Moreover, reduction in pain and neurological function did not differ with or without additional stabilization and extend of decompression. However, patients who received one-segment (-26.7%) or multi-segment (-27.5%) stabilization experienced significantly less reduction in disability after surgery compared with those who were not stabilized (-31.6%; p < 0.05).

Conclusions: Among seniors undergoing spinal stenosis surgery, recovery was largely complete by 3 to 6 months after surgery, and differed little by type of surgery independent of symptoms prior to surgery and other covariates. However, particularly neurological dysfunction and disability may improve more with less invasive surgery.