Screening Tool for Bleeding Disorders in Women with Menorrhagia: Evaluation in a Prospective US Multi-Site Cohort.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1237-1237
Author(s):  
Claire S. Philipp ◽  
Ambarina Faiz ◽  
Vanessa Byams ◽  
Connie H. Miller ◽  
John A. Heit ◽  
...  
Keyword(s):  
Primary Care ◽  
Black Women ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Reproductive Age ◽  
Adult Women ◽  
Bleeding Disorders ◽  
Reproductive Age Women ◽  
Testing And Evaluation ◽  
Selection Of

Abstract Menorrhagia is a common clinical problem among reproductive age women and annually 5% of reproductive age women seek medical attention, usually with gynecologists and other primary care physicians, for this symptom. Since underlying bleeding disorders are common in women presenting with menorrhagia, and referral for comprehensive hemostatic testing of substantial numbers of women with otherwise unexplained menorrhagia is problematic from the public health and cost perspective, a short, easy-to-administer screening tool comprised of 8 questions for identifying women with menorrhagia for hemostatic evaluation was previously developed (Am J Ob Gyn2008;198:e1–163e8). In the present study, the validity of the screening tool was evaluated in a multi-site, prospectively recruited cohort of women with menorrhagia. 232 women with menorrhagia age 18 and older with a pictorial blood assessment chart (PBAC) score > 100 were recruited from 5 US centers as potential subjects for a prospective cross-over study for evaluation of intranasal DDAVP versus tranexamic acid. All subjects underwent comprehensive laboratory testing for bleeding disorders, including VWF, platelet aggregation/ATP release, and factor assays. Study participants were administered a questionnaire which included the 8 screening tool questions in 4 categories, including history of duration and severity of menorrhagia, anemia treatment, excessive bleeding with hemostatic challenges, and family diagnosis of bleeding disorder. A screening tool was considered positive if there was a positive response for any of the questions in the four categories. Sensitivity of the screening tool with 95% confidence interval was calculated for bleeding disorders and also separately for low VWF (ristocetin cofactor < 50%), and platelet function defects.217 women with menorrhagia including 78% white and 16% black women with complete data were evaluated. In this population, a positive screening tool had a sensitivity of 89% (95% CI, 83–93) for bleeding disorders, 89% for platelet function defects (95% CI, 82–94), and 73% for low VWF (95% CI, 39–94). The sensitivity for bleeding disorders was 87% (95% CI, 79–92) among white women and 94% (95% CI, 79–99) among black women. Adding a PBAC score > 185 increased the sensitivity of the screening tool for bleeding disorders to 95% (95% CI, 90–98). Using a multi-site US population of adult women with menorrhagia, this study confirms the benefit of a short screening tool to assist primary care physicians in the selection of women with menorrhagia to refer for comprehensive hemostatic testing and evaluation. population of adult women with menorrhagia, this study confirms the benefit of a short screening tool to assist primary care physicians in the selection of women with menorrhagia to refer for comprehensive hemostatic testing and evaluation.

A quick dementia screening tool for primary care physicians

2011 ◽  
Vol 53 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Chin-Ying Chen ◽  
Kai-Kuen Leung ◽  
Ching-Yu Chen
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Dementia Screening

scholarly journals Contraception in obese women

2016 ◽  
Vol 13 (3) ◽  
pp. 65-69
Author(s):  
Elena Andreeva ◽  
Dar’y Sokolova ◽  
Ol'ga Grigoryan
Keyword(s):  
Reproductive Age ◽  
Modern World ◽  
Specific Method ◽  
Obese Patients ◽  
Obese Women ◽  
Overweight People ◽  
Reproductive Age Women ◽  
Carbohydrate And Lipid Metabolism ◽  
Gynecological Diseases ◽  
Selection Of

At present, the prevalence of overweight people in the world is more than 1.7 billion; 312 million people are obese. The 25% of them consist of reproductive age women. In the modern world contraception is not only the way to prevent unscheduled pregnancy but also the opportunity to treat endocrine and gynecological diseases. While choosing the method of contraception, it is important to realize it’s pharmacological effect on carbohydrate and lipid metabolism, hemocoagulation/fibrinolysis system, cardiovascular and other systems of body that are involved in cascade of pathological processes. Selection of contraception for overweight/obese patients needs an individualized approaches with evaluation of efficiency/risk for every specific method of fertility correction.

Consultation-Liaison Psychiatry Fellowship in Primary Care

1996 ◽  
Vol 26 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Maurice D. Steinberg ◽  
Steven A. Cole ◽  
Stephen M. Saravay
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Liaison Psychiatry ◽  
Service Staff ◽  
Consultation Liaison Psychiatry ◽  
Primary Care Practitioners ◽  
Primary Care Medicine ◽  
Selection Of

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

scholarly journals Persisting high magnitude of anaemia in Women of Reproductive age

2019 ◽  
pp. 65-71
Author(s):  
Chhabra S ◽  
Poonam Varma Shivkumar ◽  
Anuradha Khandekar
Keyword(s):  
Eating Habits ◽  
Ethics Committee ◽  
Reproductive Age ◽  
Bleeding Disorders ◽  
Research Assistant ◽  
Inclusion Criteria ◽  
Women Of Reproductive Age ◽  
Economic Class ◽  
Reproductive Age Women ◽  
High Magnitude

Background: Despite several steps taken by governments, anaemia remains a major cause of ill health in women globally, maybe it is increasing. Objectives: Study was done to know magnitude of anaemia in women of reproductive age (WRA, 15-49 yrs) with mission of services. Materials and Methods: It was institution based prospective study for knowing magnitude of anaemia in WRA. Study was carried out over 9 months in Obstetrics & Gynaecology, after approval of ethics committee of institute. Study subjects were non-pregnant women of 15-49 years of age who reported to hospital with various disorders, but did not have any disorder which could have been responsible for anaemia. Patients’ friends, relatives who volunteered to be part of study were also included. Women with known bleeding disorders, or obvious causes for anaemia like menorrhagia, piles, chronic diseases were not included. Pretested tool was used. As per inclusion criteria women from regular counter of obstetrics gynaecology outpatient. were directed to research assistant. Results: Adolescents had maximum burden of anaemia, 76.15%, followed by 69.45% among women of 20-34 yrs, 65.21% in women of 35-49 yrs age. Severely anaemic were 2.02% among adolescents, 0.44% of 20-34 years ,0.27% among of 35-49 yrs. As expected, highest numbers were amongst women of low socio-economic class and illiterate. Conclusion: Around seventy percent women of reproductive age with no obvious cause were anaemic, more of adolescents. It is essential that in depth studies are done about available food, eating habits, as anaemia continues to kill many mothers during pregnancy, birth, postbirth and affects baby too. Keywords: Anaemia; Reproductive Age Women; No Obvious Cause

Primary Care Physicians' Selection of Verbal Compliance-Gaining Strategies

1990 ◽  
Vol 2 (1) ◽  
pp. 13-27 ◽  
Author(s):  
Michael Burgoon ◽  
Roxanne Parrot ◽  
Judeee K. Burgoon ◽  
Thomas Birk ◽  
Michael Pfau ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Compliance Gaining ◽  
Selection Of

scholarly journals Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Mitalee P. Christman ◽  
Margarita Castro-Zarraga ◽  
Doreen DeFaria Yeh ◽  
Richard R. Liberthson ◽  
Ami B. Bhatt
Keyword(s):  
Primary Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cancer Screening ◽  
Primary Care Physicians ◽  
Congenital Heart ◽  
Care Center ◽  
Adult Women ◽  
Cancer Society ◽  
Pap Tests

Adults with congenital heart disease (ACHD) face noncardiac healthcare challenges as the population ages. We assessed whether women with ACHD have comparable cancer screening rates to non-ACHD women in a cardiac practice and to the general population. We performed a retrospective review of 175 adult women seen in a cardiac care center in 2009–2011. Data on Pap tests, mammography, and colonoscopies, were collected through electronic medical records and primary care provider records. Adequate documentation was available for 100 individuals with ACHD and 40 comparator cardiac patients. The adequacy of screening was determined using guidelines set forth by the American Cancer Society in 2010. Compared with the national average, ACHD patients had significantly lower rates of Pap tests (60% versus 83%, ) and mammography (48% versus 72%, ). Compared with non-ACHD women in the same practice, ACHD patients had consistently lower rates of mammography (48% versus 81%, ) and colonoscopies (54% versus 82%, ). As the population of ACHD individuals ages, attention to cancer screening becomes increasingly important but may be overlooked in this population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for this growing population.

scholarly journals THU0560 PRIMARY CARE PHYSICIAN PERSPECTIVES ON DELAYS IN DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: A QUALITATIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 521.1-521
Author(s):  
S. H. Liu ◽  
K. Lapane ◽  
D. Shridharmurthy ◽  
S. Khan ◽  
K. Ferrucci ◽  
...  
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Primary Care Physicians ◽  
Laboratory Tests ◽  
Screening Tool ◽  
Axial Spondyloarthritis ◽  
Diagnostic Delay ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Average Delay

Background:The average delay in diagnosis for patients with any form of spondyloarthritis (SpA) ranges from 7 to 10 years [1–5]. In axial spondyloarthritis (axSpA), a subgroup of SpA, it is 5 to 14 years [4, 6, 7]. Factors that contribute to this delay include the lack of diagnostic criteria for axSpA and the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA, from other highly prevalent forms of low back pain [8–10]. This impedes timely referral of these patients to rheumatologic care and initiation of appropriate treatment.Objectives:Describe understanding of, attitudes towards, and practices regarding axSpA among primary care physicians.Methods:We recruited 18 primary care physicians practicing in the United States as part of a larger qualitative study: theSpondyloArthritisScreening andEarlyDetection (SpA-SED) Study. We used purposive sampling with a goal of including an equal number of family medicine and internal medicine physicians who were balanced by gender. Physicians provided informed consent to participate in an in-depth interview (up to 60 minutes), conducted in person (n = 3) or over the phone (n = 15), between February and May 2019. The interview guide was developed by a multidisciplinary team, with input from rheumatologists. Topics included the physicians’ approaches to evaluating back pain, their awareness about axSpA, their differential diagnosis of axSpA, the laboratory tests and imaging studies ordered when axSpA is suspected, their referral patterns for patients with presumed axSpA, their thoughts about factors contributing to diagnostic delay in axSpA, and their opinions about an Inflammatory Back Pain Assessment – ASAS criteria screening tool [5].Results:Barriers to early diagnosis included patient factors (eg, multiple complaints, back pain not being the chief complaint), disease characteristics (eg, slow rate of disease progression), physician characteristics (eg, lack of rapport between patients and their primary care physicians), and structural/system issues (eg, lack of time). Most physicians reported that they would perform laboratory tests before referring a patient to a rheumatologist.Conclusion:Primary care physicians were surprised to learn of the average delay to axSpA diagnosis, considered that this lengthy delay was problematic, and agreed that improvements are needed in screening for and early detection of axSpA. Physicians believed that there would be a role for using a screening tool in the primary care setting to improve diagnostic delay, but that evidence to support its implementation is needed.References:[1]Dougados M et al.Arthritis Rheum.1991;34:1218–27.[2]Amor B et al.Rev Rhum Mal Osteoartic.1990;57:85–9.[3]van der Linden S et al.Arthritis Rheum.1984;27:361–8.[4]Deodhar A et al.Arthritis Rheumatol.2016;68:1669–76.[5]Sieper J et al.Ann Rheum Dis.2009;68:784–8.[6]Sykes MP et al.Rheumatology (Oxford).2015;54:2283–4.[7]Redeker I et al.Rheumatology (Oxford).2019;58:1634–8.[8]Strand V et al.Mayo Clin Proc.2017;92:555–64.[9]Proft F et al.Ther Adv Musculoskelet Dis. 2018;10:129–39.[10]Bohn R et al.Clin Exp Rheumatol.2018;36: 263–74.Acknowledgments:We thank the participants for sharing their insights as part of this study. This abstract was written using data from a research study originally funded by Novartis (Principal Investigator: Shao-Hsien Liu, Co-Investigators: Jonathan Kay, Kate Lapane, Catherine Dubé).Disclosure of Interests:Shao-Hsien Liu Grant/research support from: Novartis Pharmaceuticals Corporation, Kate Lapane Grant/research support from: Novartis Pharmaceuticals Corporation, Divya Shridharmurthy Grant/research support from: Novartis Pharmaceuticals Corporation, Sara Khan Grant/research support from: Novartis Pharmaceuticals Corporation, Katarina Ferrucci Grant/research support from: Novartis Pharmaceuticals Corporation, Catherine Dubé Grant/research support from: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Jonathan Kay Grant/research support from: Gilead Sciences, Inc., Pfizer, Novartis Pharmaceuticals Corporation, Consultant of: Alvotech Suisse AG; Arena Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Merck Sharp & Dohme Corp.; Mylan Inc.; Novartis AG; Samsung Bioepis; Sandoz, Inc; UCB, Inc.

scholarly journals Primary care physician perspectives on screening for axial spondyloarthritis: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252018
Author(s):  
Kate L. Lapane ◽  
Divya Shridharmurthy ◽  
Sara Khan ◽  
Daniel Lindstrom ◽  
Ariel Beccia ◽  
...  
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Pain Assessment ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Inflammatory Back Pain ◽  
Care Practice ◽  
Primary Care Settings ◽  
Work Up ◽  
Expert Criteria

Background Many patients with axial spondylarthritis (axSpA) experience lengthy diagnostic delays upwards of 14 years. (5–14 years). Screening tools for axSpA have been proposed for use in primary care settings, but whether this approach could be implemented into busy primary care settings remains unknown. Objective To solicit feedback from primary care physicians regarding questions from the Inflammatory Back Pain Assessment: the Assessment of Spondyloarthritis International Society (ASAS) Expert Criteria and gain insight about barriers and facilitators for implementing axSpA screening in primary care. Methods Guided by Consolidated Criteria for reporting Qualitative Research (COREQ-criteria), we recorded, transcribed, and analyzed in-depth interviews with eight family medicine physicians and ten internists (purposeful sampling) using immersion/crystallization techniques. Results Few physicians reported awareness of existing classification criteria for axSpA, and many reported a lack of confidence in their ability to distinguish between inflammatory and mechanical back pain. From three domains, 10 subthemes emerged: 1) typical work-up of axSpA patients in primary care, with subthemes including the clues involved in work-up and role of clinical examinations for axSpA; 2) feedback on questions from the Inflammatory Back Pain Assessment: ASAS Expert Criteria, with subthemes to evaluate contents/questions of a potential screening tool for axSpA; and 3) implementation of the screening tool in primary care settings, with subthemes of perceived barriers including awareness, time, other conditions to screen, rare disease, and lack of structured questionnaire for back pain and perceived facilitators including workflow issues and awareness. Conclusions Primary care physicians believed that an improved screening instrument and a strong evidence-base to support the need for screening for axSpA are required. The implementation of axSpA screening into a busy primary care practice requires integration into the practice workflow, with use of technology suggested as a possible way to improve efficiency.

scholarly journals What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vivian Nystrøm ◽  
Hilde Lurås ◽  
Patrik Midlöv ◽  
Ann-Chatrin Linqvist Leonardsen
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
User Participation ◽  
Hospital Emergency ◽  
Nurses And Physicians ◽  
Hospital Emergency Departments ◽  
Medical Competence ◽  
Selection Of Patients ◽  
Selection Of

Abstract Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

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