scholarly journals Cough variant asthma and atopic cough

2010 ◽  
Vol 5 ◽  
Author(s):  
Chiara Magni ◽  
Elisa Chellini ◽  
Alessandro Zanasi
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Chronic Cough ◽  
Primary Care Physicians ◽  
Ace Inhibitor ◽  
Cough Variant Asthma ◽  
The Third ◽  
The World ◽  
Normal Chest ◽  
Atopic Cough

Chronic cough has been reported to be the fifth most com- mon complaint seen by primary care physicians in the world, the third in Italy. Chronic cough in non-smoking, non-treated with ACE-inhibitor adults with normal chest radiogram could be a symptom of asthma and can be sub-classified into: cough-variant asthma, atopic cough, and eosinophilic bron- chitis. This review discusses the differential diagnosis of these three disorders.

Teaching Normal and Abnormal Behavior to Primary Care Physicians

1994 ◽  
Vol 24 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Uriel Halbreich
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Human Behavior ◽  
Primary Care Physicians ◽  
Family Physicians ◽  
Abnormal Behavior ◽  
General Internists ◽  
Education Committee ◽  
Personal Skills

Objective: This article delineates the framework for a curriculum on psychiatry, normal and abnormal human behavior for primary care physicians (PCPs). Methods: Curricula have been surveyed. Members of the Education Committee of the Association of Medicine and Psychiatry, as well as Family Physicians and General Internists involved in education have been consulted. Their recommendations are integrated. Results and Conclusions: The curriculum should be developed according to the needs of PCPs and from their perspective. Patient and problem-oriented, its content can be divided into: a) personal skills that should be developed; and b) knowledge of symptoms, their differential diagnosis (DDX) and management within the PCP's, facilities and abilities.

Depression as a Systemic Illness

2018 ◽  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Collaborative Care ◽  
Primary Care Physicians ◽  
Depressive Disorders ◽  
Developed Countries ◽  
Care Physician ◽  
World Health ◽  
Mental Health Training ◽  
The World

Depression has been declared by the World Health Organization in March of 2017 to be the illness with the greatest burden of disease in the world. This volume attempts to examine the current state of our understanding of depressive disorders, from the animal models, allostatie load, patterns of recurrence, effects on other illnesses, for example, cancer, neurological, cardiovascular, wound healing, etc. It is from this perspective that the editors declare that depression is a systemic illness, not just a mental disorder. Therefore, primary care physicians need to know how to diagnose, treat, and refer when necessary for the non-complicated, non-refractory forms of depression. From this perspective models of mental health training for the primary care physician are reviewed. Then a new model, the medical model, a step beyond collaborative care is described. Non complicated depressive illness needs to be addressed by the primary care physician much as they do asthma, diabetes, hyptertension, and congestive heart failure. Even collaborative care models are unable as the number of psychiatrists is too few even in developed countries, let alone in developing ones to work with primary care. Medical schools and residency training programs need to incorporate curriculum and clinical experiences to accommodate developing expertise to diagnose, treat, and refer when necessary in this most common medical malady. Finally, a modified electronic medical record is proposed as a collaborating agent for the primary care physician.

scholarly journals Coughing children in family practice and primary care: a systematic review of prevalence, aetiology and prognosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Milena Bergmann ◽  
Jörg Haasenritter ◽  
Dominik Beidatsch ◽  
Sonja Schwarm ◽  
Kaja Hörner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Respiratory Tract ◽  
Chronic Cough ◽  
Primary Care Physicians ◽  
Original Research ◽  
Current Guideline ◽  
Upper Respiratory Tract ◽  
Acute Cough ◽  
Tract Infections

Abstract Background For evidence-based decision making, primary care physicians need to have specific and reliable information on the pre-test probabilities of underlying diseases and a symptom’s course. We performed a systematic review of symptom-evaluating studies in primary care, following three research questions: (1) What is the prevalence of the symptom cough in children consulting primary care physicians? (2) What are the underlying aetiologies of cough and the respective frequencies? (3) What is the prognosis of children with cough? Methods Following a pre-defined algorithm and independent double reviewer ratings we searched MEDLINE and EMBASE. All quantitative original research articles in English, French or German were included if they focused on unselected study populations of children consulting a primary care physician for cough. We used the random effects model for meta-analysis in subgroups, if justifiable in terms of heterogeneity. Results We identified 14 eligible studies on prevalence, five on aetiology and one on prognosis. Prevalence estimates varied between 4.7 and 23.3% of all reasons for an encounter, or up to estimates of 60% when related to patients or consultations. Cough in children is more frequent than in adults, with lowest prevalences in adolescents and in summer. Acute cough is mostly caused by upper respiratory tract infections (62.4%) and bronchitis (33.3%); subacute or chronic cough by recurrent respiratory tract infection (27.7%), asthma (up to 50.4% in cough persisting more than 3 weeks), and pertussis (37.2%). Potentially serious diseases like croup, pneumonia or tuberculosis are scarce. In children with subacute and chronic cough the total duration of cough ranged from 24 to 192 days. About 62.3% of children suffering from prolonged cough are still coughing two months after the beginning of symptoms. Conclusion Cough is one of the most frequent reasons for an encounter in primary care. Our findings fit in with current guideline recommendations supporting a thoughtful wait-and-see approach in acute cough and a special awareness in chronic cough of the possibility of asthma and pertussis. Further evidence of aetiological pre-test probabilities is needed to assess the diagnostic gain based on patient history and clinical signs for differential diagnoses of cough in children.

scholarly journals Management of Patients with COVID-19 at the Level OF PMC in Ukraine: Analysis of the Results of the Survey of Family Doctors in Comparison with Worldwide

2021 ◽  
pp. 5-11
Author(s):  
Oksana Ilkov ◽  
Pavlo Kolesnyk
Keyword(s):  
Primary Care ◽  
Comparative Analysis ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Treatment Strategies ◽  
Family Physicians ◽  
Infectious Agent ◽  
Diagnostic Methods ◽  
Family Doctors ◽  
The World

The emergence of the new infectious agent SARS COVID-19 quickly led to an epidemic and later a pandemic in 2020. Currently, the world has accumulated enough descriptive data on the management of patients with COVID-19, but many countries have not yet clearly developed evidence protocols for different levels medical care. Therefore, it is actual to conduct a comparative analysis of the management of patients with coronavirus infection at the level of PMC in different countries. The objective: to conduct a comparative analysis of the management of COVID-19 patients at the level of PMC in different countries and in Ukraine. Materials and methods. Data from family physicians from 9 countries on the management of COVID-19 patients at the PMC level (which were presented in the form of reports with answers to 5 questions at the international conference «Hot topic: COVID-19 and comorbid conditions in primary care» 3–5 December 2020). The results of a survey of Ukrainian family doctors conducted by an online survey were also evaluated. The answers of Ukrainian family doctors were received in the process of anonymous questionnaires in the format of Google-forms from November to December 2020. Results. The analysis of reports of international experts and survey data of domestic doctors revealed similar features in treatment strategies, diagnosis and control strategies for recovery of patients at the level of PMC: for example, assessment of the patient’s condition by pulse oximetry, respiratory rate, telephone and video triage etc. However, certain directions in the domestic routine medical practice differed significantly from those in the management of patients by family physicians in the world (for example, the widespread use of antibiotics, anticoagulants and many other additional means, frequent unjustified use of CT by primary care physicians colleagues at the PMC level. Conclusions. A comparative analysis of diagnosis and treatment revealed both similar (diagnostic methods, assessment of patients’ condition) and distinctive features (hyperdiagnosis and оver-treatment) in the management of COVID-19 in Ukraine, compared to global strategies.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study

10.2196/16700 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e16700 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

Background Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

BACKGROUND Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. OBJECTIVE Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. METHODS This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. RESULTS Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. CONCLUSIONS Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals Childhood chronic cough made easy: a simplified approach for the primary care setting

2021 ◽  
Vol 49 (2) ◽  
pp. 170-177
Author(s):  
Grigorios Chatziparasidis ◽  
Sotirios Fouzas ◽  
Ahmad Kantar
Keyword(s):  
Primary Care ◽  
Chronic Cough ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Defense Mechanism ◽  
Negative Impact ◽  
Care Physician ◽  
Simplified Approach ◽  
Clinical Scenarios

Cough is a defense mechanism, but when it becomes persistent and troublesome, it must be carefully assessed. Chronic cough, that is, cough persisting for more than 4 weeks, has a proven negative impact on a child’s quality of life; it interferes with daily activities, sleep, and schooling and may involve frequent health care visits and long-lasting treatments. Currently, there is a plethora of algorithms in the literature aiming to assist in the assessment of chronic cough in children; however, referring to complex flowcharts may be impractical for the usually busy primary care physician. Herein, we provide a simplified tool for the assessment of children with chronic cough in the primary care setting, presenting a basic approach to the most common causes along with hints to avoid common pitfalls in everyday practice. Finally, the most common clinical scenarios are analyzed, aiming to assist primary care physicians in providing the appropriate care to these patients.

Sudden Airway Obstruction Due to Pedunculated Laryngeal Polyps

1983 ◽  
Vol 92 (4) ◽  
pp. 340-343 ◽  
Author(s):  
Jeffrey N. Hausfeld ◽  
Eiji Yanagisawa ◽  
Myles L. Pensak
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Early Diagnosis ◽  
Airway Obstruction ◽  
Primary Care Physicians ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Diagnosis And Treatment ◽  
Respiratory Obstruction

Acute upper airway obstruction from laryngeal polyps is uncommon. However, a large pedunculated laryngeal polyp, when unrecognized, may produce sudden airway obstruction. The importance of an early diagnosis and treatment is stressed. Primary care physicians, endoscopists, anesthesiologists, and otolaryngologists should be aware of this condition and add it to their differential diagnosis of sudden respiratory obstruction.

scholarly journals Criteria and instruments of appropriateness in primary care

2008 ◽  
Vol 2 (2) ◽  
pp. 83-88
Author(s):  
Andrea Pizzini
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
World Health ◽  
Wide Range ◽  
The World ◽  
Disease Mongering ◽  
Health Organization ◽  
Explicit Criteria ◽  
Real Clinical Practice

The World Health Organization describes three particular features to assess the appropriateness of most medical services provided by clinicians during typical primary care visits: equity, efficacy and effectiveness. But many others aspects are involved and primary care physicians provide a wide range of services, most of which have not been studied sufficiently to develop explicit criteria for appropriateness. This articles describes meaning and characteristics of appropriateness in primary care and underlines the most important difficulties met by general practitioners, from the so called “disease mongering” to the application of the results of trials into the real clinical practice.

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