The Medical clinics of North America
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Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. ⋯ All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.
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Insomnia is a common condition affecting approximately 50% of people at some point. Physicians must be equipped to diagnose and treat it as part of outpatient practice. ⋯ The 2 methods of treatment are psychological, which is preferred, and pharmacologic, for when behavioral therapies are not effective. It is important to understand the various behavioral interventions and risks and benefits of the medications available to engage patients in a shared decision-making model to find the best treatment for each patient.
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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.
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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.