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Primary care updates

France Légaré, Rhéda Adekpedjou, Dawn Stacey, Stéphane Turcotte, Jennifer Kryworuchko, Ian D Graham, Anne Lyddiatt, Mary C Politi, Richard Thomson, Glyn Elwyn, Norbert Donner-Banzhoff
BACKGROUND: Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES: To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both...
July 19, 2018: Cochrane Database of Systematic Reviews
Juan Manuel Diez Tetamanti, Eduardo Rocha, Glauco Munsberg, Jessica Helena Peixoto Castro, Aline Dos Santos Neutzling, Sergio Fernando Jaime, Leonardo Javier Schuler
Community health agents carry out significant actions on the ground to provide prevention and care and bring health services to families. These practices in the field constitute a constant collective mapping process using the knowledge of the territory that the agents possess. Based on intensive fieldwork starting in 2012 in conjunction with local social organizations and health institutions in Brazil and Argentina, the binational project App+Health (App+Salud in Spanish and App+Saúde in Portugués) was initiated...
January 2018: Salud Colectiva
Tomas Kazda, Adam Dziacky, Petr Burkon, Petr Pospisil, Marek Slavik, Zdenek Rehak, Radim Jancalek, Pavel Slampa, Ondrej Slaby, Radek Lakomy
Background: The current standard of care of glioblastoma, the most common primary brain tumor in adults, has remained unchanged for over a decade. Nevertheless, some improvements in patient outcomes have occurred as a consequence of modern surgery, improved radiotherapy and up-to-date management of toxicity. Patients from control arms (receiving standard concurrent chemoradiotherapy and adjuvant chemotherapy with temozolomide) of recent clinical trials achieve better outcomes compared to the median survival of 14...
June 2018: Radiology and Oncology
Victoria Whitelock, Arie Nouwen, Katrijn Houben, Olga van den Akker, Miranda Rosenthal, Suzanne Higgs
AIMS: Controlling food intake despite adequate knowledge remains a struggle for many people with type 2 diabetes. The present study investigated whether working memory training can reduce food intake and improve glycaemic control. It also examined training effects on cognition, food cravings, and dietary self-efficacy and self-care. METHODS: In a double-blind multicentre parallel-group randomised controlled trial, adults with type 2 diabetes mellitus were randomly allocated to receive 25 sessions of either active (n = 45) or control (n = 36) working memory training...
July 11, 2018: Diabetes Research and Clinical Practice
Miranda Laurant, Mieke van der Biezen, Nancy Wijers, Kanokwaroon Watananirun, Evangelos Kontopantelis, Anneke Jah van Vught
BACKGROUND: Current and expected problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of primary care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing...
July 16, 2018: Cochrane Database of Systematic Reviews
Kathryn E Fay, Lauren A Farina, Heather R Burks, Robert A Wild, Neil J Stone
The obstetrician/gynecologist frequently serves as the primary care physician for women. Specialty-specific guidelines vary in screening recommendations for lipid disorders; women's health practitioners often follow recommendations to screen at age 45 in the absence of other risk factors. However, 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend screening at age 21 to capture those at risk of cardiovascular disease and allow for early intervention with lifestyle and, in the most severe cases, evidence-based statins...
July 13, 2018: Journal of Women's Health
Y Maharaj, A Robinson, D McIntyre
BACKGROUND: Inequity in resource allocation and expenditure exists in the South African (SA) health system at provincial and district level. Needs-based resource allocation has been utilised in developed and developing countries to promote equity. OBJECTIVES: To assess current spending patterns on primary healthcare (PHC)-level care at district level, and ultimately to promote equity in district PHC spending using a needs-based resource allocation approach in North West Province, SA...
February 27, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Nora Taylor
Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners' understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacologic and pharmacologic therapies to achieve a maximal clinical benefit. The focus of this review is on the nonsurgical options for treatment of knee osteoarthritis in patients aged 65 and older...
August 2018: Rheumatic Diseases Clinics of North America
Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer
PURPOSE: Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001. METHODS: This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris. RESULTS: From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study...
June 2018: Annals of Coloproctology
Jorge J Castillo, Brady E Beltran, Roberto N Miranda, Ken H Young, Julio C Chavez, Eduardo M Sotomayor
DISEASE OVERVIEW: Epstein Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) is an entity included in the 2016 WHO classification of lymphoid neoplasms. EBV+ DLBCL, NOS, is an aggressive B-cell lymphoma associated with chronic EBV infection, and a poor prognosis with standard chemotherapeutic approaches. DIAGNOSIS: The diagnosis is made through a careful pathological evaluation. Detection of EBV-encoded RNA is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined...
July 2018: American Journal of Hematology
Leopold Ndemnge Aminde, Noah Fongwen Takah, Belen Zapata-Diomedi, J Lennert Veerman
Background: Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods: In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC...
2018: Cost Effectiveness and Resource Allocation: C/E
James H Tabibian, Christopher L Bowlus
Primary sclerosing cholangitis (PSC) is a rare, chronic, cholestatic liver disease of uncertain etiology characterized biochemically by cholestasis and histologically and cholangiographically by fibro-obliterative inflammation of the bile ducts. In a clinically significant proportion of patients, PSC progresses to cirrhosis, end-stage liver disease, and/or hepatobiliary cancer, though the disease course can be highly variable. Despite clinical trials of numerous pharmacotherapies over several decades, safe and effective medical therapy remains to be established...
December 2017: Liver Research
Steven R Levine, Sarah Z Weingast, Jeremy Weedon, Dimitre G Stefanov, Patricia Katz, Dana Hurley, Scott E Kasner, Pooja Khatri, Joseph P Broderick, James C Grotta, Edward Feldmann, Peter D Panagos, Jose G Romano, Riccardo Bianchi, Brett C Meyer, Phillip A Scott, Doojin Kim, Clotilde Balucani
BACKGROUND AND PURPOSE: The 2015 updated US Food and Drug Administration alteplase package insert altered several contraindications. We thus explored clinical factors influencing alteplase treatment decisions for patients with minor stroke. METHODS: An expert panel selected 7 factors to build a series of survey vignettes: National Institutes of Health Stroke Scale (NIHSS), NIHSS area of primary deficit, baseline functional status, previous ischemic stroke, previous intracerebral hemorrhage, recent anticoagulation, and temporal pattern of symptoms in first hour of care...
July 5, 2018: Stroke; a Journal of Cerebral Circulation
Gajanan Phutke, Timothy Laux, Priyank Jain, Yogesh Jain
The Pre-Conception and Pre-Natal Diagnostic Techniques Act was written to prevent societally unacceptable harms including intentional sex selection. The pragmatism required to enforce this law has profound effects on the ability of rural Indians to access diagnostic ultrasonography. In so doing, it may have inadvertently placed a heavier burden on the poorest and worsened health inequity in India, creating serious ethical and justice concerns. It is time to re-examine and update the law such that diagnostic ultrasonography is widely available in even the most peripheral primary health and community health centres...
May 18, 2018: Indian Journal of Medical Ethics
Selma Audi, Daniel R Burrage, Dagan O Lonsdale, Sarah Pontefract, Jamie J Coleman, Andrew W Hitchings, Emma H Baker
AIMS: Prescribing is a complex skill required of doctors and, increasingly, other healthcare professionals. Use of a personal formulary can help to develop this skill. In 2006-9, we developed a core list of the 100 most commonly prescribed drugs. Our aim in the present study was to update this 'starter formulary' to ensure its continued relevance for prescriber training. METHODS: We analysed large contemporary primary and secondary care datasets to identify the most frequently prescribed medicinal products...
July 5, 2018: British Journal of Clinical Pharmacology
Crystian B Oliveira, Chris G Maher, Rafael Z Pinto, Adrian C Traeger, Chung-Wei Christine Lin, Jean-François Chenot, Maurits van Tulder, Bart W Koes
OBJECTIVE: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. We also aimed to examine how recommendations have changed since our last overview in 2010. METHOD: The searches for clinical practice guidelines were performed for the period from 2008 to 2017 in electronic databases. Guidelines including information regarding either the diagnosis or treatment of non-specific low back pain, and targeted at a multidisciplinary audience in the primary care setting, were considered eligible...
July 3, 2018: European Spine Journal
Philipp Schuetz, Rebekka Bolliger, Meret Merker, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Charles E Luyt, Michel Wolff, Stefan Schroeder, Vandack Nobre, Konrad Reinhart, Angela Branche, Pierre Damas, Maarten Nijsten, Rodrigo O Deliberato, Alessia Verduri, Bianca Beghé, Bin Cao, Yahya Shehabi, Jens-Ulrik S Jensen, Albertus Beishuizen, Evelien de Jong, Matthias Briel, Tobias Welte, Beat Mueller
Introduction Although evidence indicates that use of procalcitonin to guide antibiotic decisions for the treatment of acute respiratory infections (ARI) decreases antibiotic consumption and improves clinical outcomes, algorithms used within studies had differences in PCT cut-off points and frequency of testing. We therefore analysed studies evaluating procalcitonin-guided antibiotic therapy and propose consensus algorithms for different respiratory infection types. Areas covered: We systematically searched randomized-controlled trials (search strategy updated on February 2018) on procalcitonin-guided antibiotic therapy of ARI in adults using a pre-specified Cochrane protocol and analysed algorithms from 32 trials that included 10,285 patients treated in primary care settings, emergency departments (ED), and intensive care units (ICU)...
July 3, 2018: Expert Review of Anti-infective Therapy
Fiona Beyer, Ellen Lynch, Eileen Kaner
Purpose of the Review: Excessive drinking is a major public health problem that adversely affects all parts of the population. Previous systematic reviews and meta-analyses have reported that brief interventions delivered in primary care are effective at reducing alcohol consumption, albeit with small effect sizes that have decreased over time. This review summarises the updated evidence base on practitioner and digitally delivered brief interventions. Recent Findings: Using Cochrane methodology, 69 primary care brief intervention trials (33,642 participants) and 57 digital intervention trials (34,390 participants) were identified...
2018: Current Addiction Reports
Marian S McDonagh, Kim Peterson, Kevin Winthrop, Amy Cantor, Brittany H Lazur, David I Buckley
Objective Antibiotic overuse contributes to antibiotic resistance and adverse consequences. Acute respiratory tract infections (RTIs) are the most common reason for antibiotic prescribing in primary care, but such infections often do not require antibiotics. We summarized and updated a previously performed systematic review of interventions to reduce inappropriate use of antibiotics for acute RTIs. Methods To update the review, we searched MEDLINE®, the Cochrane Library (until January 2018), and reference lists...
January 1, 2018: Journal of International Medical Research
Marie Claire Van Hout, Des Crowley, Aoife McBride, Ide Delargy
BACKGROUND: Treatment for opioid dependence in Ireland is provided predominantly by general practitioners (GP) who have undergone additional training in opioid agonist treatment (OAT) and substance misuse. The National Methadone Treatment Programme (MTP) was introduced in 1998, and was designed to treat the opioid dependent population and to regulate the prescribing regimes at the time. The past two decades have seen the increased prescribing of methadone in primary care and changes in type of opioid abused, in particular, the increased use of over the counter (OTC) and prescription medications...
June 30, 2018: BMC Family Practice
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