The Medical clinics of North America
-
Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. ⋯ Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.
-
Med. Clin. North Am. · Jan 2021
ReviewManaging the Forgetful Patient: Best Practice for Cognitive Impairment.
The primary care physician is well positioned to identify and treat patients with cognitive impairment (CI). Simple, validated tools can screen for CI in the office. ⋯ A patient-centered, multidisciplinary team approach includes nonpharmacological and pharmacologic treatments. Patient safety and preservation of functional status should be at the forefront of caring for the forgetful patient.
-
Cough is a common presenting symptom for patients in a primary care setting. Chronic cough is defined as a cough lasting for more than 8 weeks. The most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease. ⋯ When there is no prevailing diagnosis, step-wise empiric trial of medication is a strategic and cost-effective approach. Certain features of chronic cough should provoke an expedited and invasive diagnostic strategy. Effectively treating patients with chronic cough has a high impact on quality of life.