No abstract

Education is central to driving change in clinical practice. First, primary care providers and their clinic team members need to understand why detecting cognitive impairment is important, how it can be done efficiently, and what the next steps in referral and management are. To engage primary care clinics in this change process, we developed a continuing education intervention, based on the KAER Model, using a live video format. Four evidence-based, 45-minute training modules presented core knowledge skills, including how to have difficult conversations, which are essential to diagnosing cognitive impairment. To overcome the obstacles to doing so in primary care, our team relied on a deep understanding of busy primary care practice. With a combined 35 years of direct experience in primary care, our collaborative interdisciplinary team was able to use the KAER Model to develop a highly acceptable intervention for primary care.

Transitional care is an important part of geriatric medicine that has not traditionally been taught to residents through formal curricula. This article reviews two online curricula available through the Portal of Geriatric Online Education. The two products reviewed here, appropriate for resident training, focus on care transitions from hospital to other care settings.

No abstract

A 2018 systematic review and meta-analysis of two randomized controlled trials (RCTs; N5740) compared the efficacy of oral proton pump inhibitor (PPI) and H2 blockers for resolution of functional dyspepsia symptoms. 1 Participants were adults with epigastric symptoms present for at least four weeks in the absence of organic disease. The two included multicenter European trials examined omeprazole (10-20 mg/d) and lansoprazole (30 mg/d) compared with control (ranitidine 150 mg 1-2 times a day) administered for 2 to 8 weeks. The primary outcome was global symptoms of dyspepsia, measured at twoweek follow-up. PPIs did not show a significant reduction in global symptoms of dyspepsia compared with H2 blockers (risk ratio 0.88; 95% CI, 0.74-1.04, I 2 551%). The studies reported no serious side effects with short-term PPI or H2 blocker. Overall, the quality of evidence was low. One trial had inadequate reporting of randomization and allocation. The other had unclear risk of bias in nearly all domains and was funded by industry.A 2017 American College of Gastroenterology and Canadian Association of Gastroenterology produced consensus guidelines for the medical management of dyspepsia. 2 For patients younger than 60 years, the guideline recommended noninvasive testing for Helicobacter pylori infection, followed by empiric medical treatment for those with negative H pylori tests or continued symptoms after successful H pylori treatment, stating that PPI therapy was the medication of choice for dyspepsia compared with H2 blockers (strong recommendation, high-quality evidence). For patients aged 60 years or older, the guideline recommended initial endoscopy to exclude neoplasia and testing for H pylori disease; if these evaluations were negative then the authors recommended medical management similar to those younger than 60 years (strong recommendation, high-quality evidence). The guideline recommendations were in part based on several heterogeneous RCTs, which on pooled analysis showed no difference in symptom relief between PPIs and H2 blockers. However, the guideline authors gave PPIs first-line preference noting that there was not a major difference in cost between PPIs and H2 blockers, and they believed that most of the studies supported PPIs over H2 blockers.