Primary care
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Parkinson disease (PD) is a progressive neurodegenerative disease with motor, nonmotor, and behavioral findings. Imaging technology advances have allowed the characterization of the underlying pathologic changes to the brain and identification of specific lesions in dopaminergic neurons. ⋯ Current treatments are directed at optimizing symptomatic management. Referral to a movement disorder specialist familiar with PD should be considered for providers with limited familiarity in diagnosis or treatment.
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Motor neuron diseases can cause progressive impairment of voluntary muscles of movement, respiration, speech, and swallowing. This review discusses the most common motor neuron disease, amyotrophic lateral sclerosis (ALS). It reviews the evaluation, diagnosis, and management of ALS, and its epidemiology, pathophysiology, and management. A coordinated approach by the primary care physician and neurologist is necessary with a focus on treatment options, durable medical equipment needs, and end-of-life discussions.
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This article provides an overview of human papillomavirus (HPV) infection and the burden of HPV-related diseases, including cervical cancer, in the United States. The article presents an overview of HPV vaccination, including the efficacy and safety of the HPV vaccine, recommendations for vaccination in the adolescent population, as well as points to counter several of the common barriers to vaccination. This information is valuable to providers in their efforts to consistently and strongly recommend HPV vaccination.
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Chronic kidney disease (CKD) has a high prevalence in the elderly population. Almost half of the population reaches moderate impairment (CKD 3) by 65 years of age. This article describes CKD staging in the geriatric population and several common clinical presentations of renal disease. ⋯ Geriatric patients are at an increased risk for renal dysfunction from many causes. Some causes are inherent with aging, such as gross structural and cellular changes, decrease in physiologic function, and lowered vascular compensatory reserve. Exposures, including medications and diagnostic testing, are contributors to acute kidney injury.
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Healthy adolescent development and successful transition to adulthood begins in the family. Supporting families in their communities and cultures ultimately makes this support system stronger. ⋯ Primary care providers are in an ideal position to support families with teens. This article reviews stressors, recommends strength-based strategies, describes how health care delivery systems can be organized to address the needs of adolescents and their families, shares a case study of a family-oriented, youth-friendly primary care clinic, and provides practical strategies for developing family-centered adolescent care within primary care practices.