scholarly journals A Review of Recent Advances in the Diagnosis and Treatment Modalities for Long Head of Bicep Tendinopathy

2016 ◽  
Vol 7 ◽  
pp. CMTIM.S39404 ◽  
Author(s):  
Robert B. Lewis ◽  
Bryan A. Reyes ◽  
Michael S. Khazzam
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Recent Literature ◽  
Biceps Tendon ◽  
Treatment Options ◽  
Diagnostic Methods ◽  
Treatment Modalities ◽  
Orthopedic Surgeons ◽  
History Of ◽  
Long Head

This article reviews the assessment and management of the pathology of the long head of the biceps tendon, a disease commonly encountered by primary care physicians and orthopedic surgeons. We include a discussion of relevant anatomy, function, pathoanatomy, natural history of the disease, diagnostic methods, and treatment options. Recent literature on the function of the long head of the bicep (LHB) is reviewed. Literature on our evolving understanding of the pathoanatomy behind LHB tendinopathy is discussed. We also discuss the effectiveness of current diagnostic and treatment modalities.

scholarly journals Physical Manipulation-Induced Femoral Neck Fracture: A Case Report

2020 ◽  
pp. 118-122
Author(s):  
Rami A. Ayoubi ◽  
Nour S. Nassour ◽  
Elias G. Saidy ◽  
Dany K. Aouad ◽  
Joseph S. Maalouly ◽  
...  
Keyword(s):  
Primary Care ◽  
Hip Fracture ◽  
Primary Care Physicians ◽  
Treatment Modalities ◽  
Cerebrovascular Accidents ◽  
Neck Fracture ◽  
History Of ◽  
Hemi Arthroplasty ◽  
History Of Parkinson’S Disease ◽  
Physical Manipulation

Manipulative treatments for pain are very widely used nowadays by a variety of physicians. These treatment modalities are generally safe, but various studies have reported serious complications. This report presents the case of a 78-year-old male patient with a history of Parkinson’s disease, who was diagnosed with a right hip fracture that occurred as a result of physical manipulative treatment. He underwent a cemented hemi-arthroplasty as appropriate surgical treatment of his condition. Manipulative treatments can result in minor and major complications ranging from simple sprains and rib fractures to cerebrovascular accidents and death. The frequency of these events seems to be rare; however, no robust studies are present and further investigations are urgently needed. Hip fractures as a result of this treatment have not been previously mentioned. This is the first reported case in the literature of a hip fracture resulting from manipulative treatment. Primary care physicians and orthopedists should be aware of the possibility of this outcome and rule it out whenever necessary.

Ethical Implications of Cultural Barriers to the Depression Diagnosis: Conversations with Primary Care Physicians

2020 ◽  
Vol 51 (9) ◽  
pp. 683-701
Author(s):  
Diana Cagliero
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Ethical Issues ◽  
Treatment Options ◽  
Cross Cultural ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Cultural Backgrounds ◽  
Ethical Implications

This article explores ethical issues raised by Primary Care Physicians (PCPs) when diagnosing depression and caring for cross-cultural patients. This study was conducted in three primary care clinics within a major metropolitan area in the Southeastern United States. The PCPs were from a variety of ethnocultural backgrounds including South Asian, Hispanic, East Asian and Caucasian. While medical education training and guidelines aim to teach physicians about the nuances of cross-cultural patient interaction, PCPs report that past experiences guide them in navigating cross-cultural conversations and patient care. In this study, semi-structured interviews were conducted with seven PCPs which were transcribed and underwent thematic analysis to explore how patients’ cultural backgrounds and understanding of depression affected PCPs’ reasoning and diagnosing of depression in patients from different cultural backgrounds. Ethical issues that arose included: limiting treatment options, expressing a patient’s mental health diagnosis in a biomedical sense to reduce stigma, and somatization of mental health symptoms. Ethical implications, such as lack of autonomy, unnecessary testing, and the possible misuse of healthcare resources are discussed.

scholarly journals History of the Development of the Treatment of Keratoconus

2013 ◽  
Vol 2 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Ramez Barbara ◽  
Lamis Abdelaziz
Keyword(s):  
Visual Acuity ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Gradual Decline ◽  
Conical Shape ◽  
Wide Range ◽  
History Of ◽  
Corneal Thinning

ABSTRACT Keratoconus (from Greek meaning horn-shaped cornea) is a degenerative, ectatic disease of the cornea, causing corneal thinning and remodelling into a more conical shape.1 Symptoms include blurring of vision, and a gradual decline in visual acuity.1 It is usually bilateral, but can affect each eye at different severities.1 There are various treatment modalities, both surgical and nonsurgical, both simple and more invasive. Here, we review the history of the development and advances of the wide range of treatment options, since it was first recognized in 1748 up until now. How to cite this article Abdelaziz L, Barbara R. History of the Development of the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2013;2(1):31-33.

scholarly journals The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fatima Cody Stanford ◽  
Erica D. Johnson ◽  
Mechelle D. Claridy ◽  
Rebecca L. Earle ◽  
Lee M. Kaplan
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Medical School ◽  
Primary Care Physicians ◽  
Massachusetts General Hospital ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Survey Respondent ◽  
Healthy Weight ◽  
Cross Sectional

Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

scholarly journals UNDERSTANDING OSTEOPOROSIS SCREENING PRACTICES IN MEN: A NATIONWIDE PHYSICIAN SURVEY

2020 ◽  
Vol 26 (11) ◽  
pp. 1237-1243
Author(s):  
Palak Choksi ◽  
Brittany L. Gay ◽  
David Reyes-Gastelum ◽  
Megan R. Haymart ◽  
Maria Papaleontiou
Keyword(s):  
Primary Care ◽  
Confidence Interval ◽  
Primary Care Physicians ◽  
Menopausal Woman ◽  
Significant Past Medical History ◽  
Endocrine Society ◽  
Osteoporosis Screening ◽  
Screening Practices ◽  
Clinical Scenarios ◽  
History Of

Objective: To understand osteoporosis screening practices, particularly in men, by a diverse cohort of physicians, including primary care physicians, endocrinologists, and geriatricians. Methods: We surveyed randomly selected members of the American Academy of Family Practice, Endocrine Society, and American Geriatrics Society. Respondents were asked to rate how often they would screen for osteoporosis in four different clinical scenarios by ordering a bone density scan. Multivariable logistic regression analyses were conducted to determine factors associated with offering osteoporosis screening in men in each clinical scenario. Physicians were also asked to note factors that would lead to osteoporosis screening in men. Results: Response rate was 63% (359/566). While 90% respondents reported that they would always or frequently screen for osteoporosis in a 65-year-old post-menopausal woman, only 22% reported they would screen a 74-year-old man with no significant past medical history. Endocrinologists were more likely to screen a 74-year-old man compared to primary care physicians (odds ratio, 2.32; 95% confidence interval, 1.10 to 4.88). In addition to chronic steroid use (94%), history of nontraumatic fractures (88%), and androgen-deprivation therapy for prostate cancer (82%), more than half the physicians reported suppressive doses of thyroid hormone (64%) and history of falls (52%) as factors leading to screening for osteoporosis in men. Conclusion: Our survey results highlight heterogeneity in osteoporosis screening in men, with underscreening in some scenarios compared to women, and identify factors that lead to screening in men. These findings can help design interventions to improve osteoporosis screening in men. Abbreviation: CI = confidence interval

scholarly journals Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030346
Author(s):  
Nina Julie Verket ◽  
Ragnhild Sørum Falk ◽  
Erik Qvigstad ◽  
Tom Gunnar Tanbo ◽  
Leiv Sandvik
Keyword(s):  
Primary Care ◽  
Family History ◽  
High Risk ◽  
Prediction Model ◽  
Early Identification ◽  
Primary Care Physicians ◽  
Lasso Regression ◽  
Cross Sectional ◽  
Predictive Values ◽  
History Of

ObjectivesTo identify predictors of disease among a few factors commonly associated with endometriosis and if successful, to combine these to develop a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis.DesignCross-sectional anonymous postal questionnaire study.SettingWomen aged 18–45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway.Participants157 women with and 156 women without endometriosis.Main outcome measuresLogistic and least absolute shrinkage and selection operator (LASSO) regression analyses were performed with endometriosis as dependent variable. Predictors were identified and combined to develop a prediction model. The predictive ability of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and positive predictive values (PPVs) and negative predictive values (NPVs). To take into account the likelihood of skewed representativeness of the patient sample towards high symptom burden, we considered the hypothetical prevalences of endometriosis in the general population 0.1%, 0.5%, 1% and 2%.ResultsThe predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. The model based on logistic regression (AUC 0.83) included these two predictors only, while the model based on LASSO regression (AUC 0.85) included two more: severe dysmenorrhea in adolescence and use of painkillers due to dysmenorrhea in adolescence. For the prevalences 0.1%, 0.5%, 1% and 2%, both models ascertained endometriosis with PPV equal to 2.0%, 9.4%, 17.2% and 29.6%, respectively. NPV was at least 98% for all values considered.ConclusionsExternal validation is needed before model implementation. Meanwhile, endometriosis should be considered a differential diagnosis in women with frequent absenteeism from school or work due to painful menstruations and positive family history of endometriosis.

Lateral Epicondylitis: A Common Cause of Elbow Pain in Primary Care

2021 ◽  
pp. 34-38
Author(s):  
Jeffrey Fleming ◽  
Christian Muller Muller ◽  
Kathryn Lambert Lambert
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Tennis Elbow ◽  
Imaging Modality ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Repetitive Motion ◽  
Lateral Epicondyle ◽  
Magnetic Resonance Imaging Mri ◽  
Standard Radiographs

Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.

Primary care pediatricians’ use of specialty referrals in treating children with chronic abdominal pain

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Shadman Memarian ◽  
Callie Pawlowski ◽  
Dmitry Tumin ◽  
Folashade A. Jose ◽  
Shaundreal D. Jamison
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Full Range ◽  
Primary Care Clinic ◽  
Chronic Abdominal Pain ◽  
Treatment Modalities ◽  
Care Clinic ◽  
Icd Codes

AbstractObjectivesPediatric chronic abdominal pain (CAP) is typically managed in primary care settings, although specialty referrals may help patients access the full range of biopsychosocial treatment options. We investigated patterns of specialty referral (gastroenterology or mental health) among children with CAP seen in an academic pediatric primary care clinic.MethodsWe retrospectively identified patients age 4–17 years visiting our primary care clinic in 2016–2017 for abdominal pain, identified using International Classification of Diseases (ICD) codes. We excluded patients whose symptoms did not persist for 3 months or who were referred to a specialist before their symptoms had persisted for 3 months. Referral outcomes were assessed through December 2018.ResultsOf 320 patients with qualifying ICD codes, 253 were excluded because their symptoms did not persist for 3 months; 31 had already been referred to a specialist within 3 months of pain onset; and one chart could not be accessed. Of the remaining 34 patients (22/12 girls/boys, median age 10 years) 10 (29%) were referred to a gastroenterologist and none were referred to mental health specialists. No clinical or demographic factors reached statistically significant associations with gastroenterology referral, although pain duration was shorter among patients who were referred.ConclusionsChildren with CAP managed in our primary care clinic were seldom referred to specialists after their pain persisted over 3 months. Increasing focus on cognitive-behavioral therapies for chronic pain, and the low specialty referral rate, indicates that primary care practices should be prepared to offer these treatment modalities to children with CAP.

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 Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician)

2021 ◽  
pp. 164-169
Author(s):  
M. S. Svetlova
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Care Physician ◽  
Diagnostic Methods ◽  
Malignant Neoplasms ◽  
Adequate Treatment ◽  
Laboratory Activity

In recent decades, there has been an increase in the number of elderly people. Among the patients of the primary care physician, without a doubt, those who are over 60 years old predominate. A feature of the elderly is polymorbidity. Combined pathology, numerous complaints of patients make it difficult to diagnose diseases, require patience from the doctor, and, of course, knowledge. There are diseases that are peculiar only to the elderly, developing only after 50 years. These include rheumatic polymyalgia. This pathology is not frequent and, in this regard, is not very familiar to outpatient therapists. However, it is to them that elderly patients turn with complaints of pain and stiffness in the shoulder and/or pelvic girdle, in the neck, in the joints of the hands, fever, weight loss, sleep disorders, depression, general malaise (the main complaints of patients with rheumatic polymyalgia). The above-mentioned clinical manifestations, as well as the high laboratory activity inherent in this disease, make the doctor look for malignant neoplasms, infectious, systemic processes. This takes a long time, the diagnosis is delayed, the sufferings of the patient are prolonged. The article presents data on the prevalence, clinical features, methods of diagnosis of rheumatic polymyalgia and its differential diagnosis. The criteria of the disease, the principles of management of the patient at the outpatient stage  (step-by-step treatment with glucocorticoids, alternative approaches, prevention of side effects of therapy, which develop quite often) are also given. Awareness of primary care physicians about rheumatic polymyalgia, its manifestations and diagnostic methods will speed up the diagnosis, timely consultation of the patient with a rheumatologist, which will allow you to start adequate treatment, significantly improve the quality of life of an elderly patient, and prevent the destabilization of concomitant diseases.

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