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Primary care updates

Dan Qiu, Mi Hu, Yu Yu, Bingwei Tang, Shuiyuan Xiao
BACKGROUND: Most of patients with dementia are cared for by family members. Caring for people with dementia is challenging; approximately 30-55% of caregivers suffered from anxiety or depressive symptoms. A range of studies have shown that psychosocial interventions are effective and can improve caregivers' quality of life, reduce their care burden, and ease their anxiety or depressive symptoms. However, information on the acceptability of these interventions, despite being crucial, is under-reported...
January 14, 2019: BMC Psychiatry
Kazuhiro Nishigami
The majority of aortic aneurysms comorbid with atherosclerosis can be asymptomatic and are discovered incidentally on routine physical examination or on imaging studies for other indications. Transthoracic echocardiography is a basic modality to assess patients with coronary artery disease and can be used for the screening of aortic aneurysm. Acute aortic dissection is a highly lethal cardiovascular emergency and requires prompt recognition. Although cardiovascular echo has a suboptimal accuracy rate for detecting aortic dissection, it is noninvasive, readily available, and easy to use...
December 25, 2018: Annals of Vascular Diseases
Nikki R Adler, John W Kelly, Pascale Guitera, Scott W Menzies, Alex J Chamberlain, Paul Fishburn, Alison E Button-Sloan, Clinton Heal, H Peter Soyer, John F Thompson
INTRODUCTION: The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality...
January 2019: Medical Journal of Australia
Xun Lian, Rishimani Adsumelli, Todd R Griffin, Tong J Gan
The opioid epidemic in the United States has become a public health crisis, which continues to worsen. The purpose of this monograph is to help obstetrician-gynecologists develop a perioperative framework with which to identify patients at risk of dependence and addiction and to describe a multimodal approach to postoperative pain management using the pathways of enhanced recovery after surgery. Preoperative counseling and optimization of comorbid medical conditions, comprehensive patient education, and optimal postoperative management also will be reviewed...
November 2018: Obstetrics and Gynecology
Marco Schreijenberg, Bart W Koes, Chung-Wei Christine Lin
Introduction Analgesic drugs are often prescribed to patients with non-specific low back pain (NSLBP). Recommendations for non-invasive pharmacological management of NSLBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy. Areas covered Recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review...
January 8, 2019: Expert Review of Clinical Pharmacology
M J Walton, J O'Connor, C Carroll, L Claxton, R Hodgson
BACKGROUND: Escalating demands upon the National Institute for Health and Care Excellence's (NICE's) Single Technology Appraisal (STA) programme require a 2.5-times increase upon 2015 capacity by 2020. This additional strain on committee resources threatens to compromise the rigour of the STA process. In 2018, NICE introduced changes to the appraisal process, aiming to expedite final decisions, including consultation opportunities prior to the company's evidence submission, a 'Technical Engagement' stage prior to the first committee meeting, and powers for committee chairs to recommend technologies without a second formal meeting...
January 8, 2019: PharmacoEconomics Open
Jeremie Calais, Johannes Czernin, Wolfgang P Fendler, David Elashoff, Nicholas Nicholas G Nickols
BACKGROUND: Salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence after prostatectomy offers long-term biochemical control in about 50-60% of patients. SRT is commonly initiated in patients with serum PSA levels < 1 ng/mL, a threshold at which standard-of-care imaging is insensitive for detecting recurrence. As such, SRT target volumes are usually drawn in the absence of radiographically visible disease. 68 Ga-PSMA-11 (PSMA) PET/CT molecular imaging is highly sensitive and may offer anatomic localization of PCa biochemical recurrence...
January 7, 2019: BMC Cancer
Gerard F Anderson, Peter Hussey, Varduhi Petrosyan
A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article's publication...
January 2019: Health Affairs
Surabhi Mishra, Ajeet Singh Bhadoria, Surekha Kishore, Raman Kumar
Gestational diabetes mellitus (GDM) has emerged as a global public health problem, both globally and in India. Despite government of India (GoI) prior mandate to screen all Indian pregnant women for GDM, its real operationalization at primary health-care level is suboptimal. Adding new operational component, GoI revised its existing recommendations and released new technical operational guidelines on GDM diagnosis and management in February 2018. The revised guideline highlights integration of two vertical programs, ensuring effective GDM service delivery to all antenatal women at every pause point of existing service delivery platform within public health system...
November 2018: Journal of Family Medicine and Primary Care
Steven J Baccei, Cole DiRoberto, Janet Greene, Max P Rosen
The primary purpose of this study is to determine if the implementation of an actionable findings communication system (PeerVue) with explicitly defined criteria for the classification of critical results, leads to an increase in the number of actionable findings reported by radiologists. Secondary goals are to 1) analyze the adoption rate of PeerVue and 2) assess the accuracy of the classification of actionable findings within this system. Over a two-year period, 890,204 radiology reports were analyzed retrospectively in order to identify the number of actionable findings communicated before (Year 1) and after the implementation of PeerVue (Year 2) at a tertiary care academic medical center...
January 5, 2019: Journal of Medical Systems
Iryna Dykun, Daniela Wiefhoff, Matthias Totzeck, Fadi Al-Rashid, R Alexander Jánosi, Tienush Rassaf, Amir A Mahabadi
Background: We aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time. Methods: We retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n = 500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70 mg/dl for 2012-2013 and 2015-2016) were evaluated...
March 2019: IJC Heart & Vasculature
M K Lim, S Cn Ha, K H Luk, W K Yip, C Sh Tsang, M Cs Wong
The Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings is updated regularly to ensure it reflects the latest medical development and best practice. In 2017, guidelines from the United States included a major change, adopting the lower blood pressure values of 130/80 mm Hg in defining hypertension, in contrast to the prevailing international consensus of 140/90 mm Hg. After thorough review of the literature and international guidelines, the Advisory Group on Hong Kong Reference Framework for Care of Diabetes and Hypertension in Primary Care Settings (Advisory Group) recommends that the definition of hypertension adopted in the Reference Framework should remain unchanged as a blood pressure of ≥140/90 mm Hg, as there is currently inadequate evidence and lack of general consensus to support such change in Hong Kong...
January 3, 2019: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Harald Chr Langaas, Eimir Hurley, Roar Dyrkorn, Olav Spigset
PURPOSE: The objective of this study was to examine the impact of an academic detailing programme in primary care in Norway on the prescribing rate of diclofenac, naproxen and non-steroidal anti-inflammatory drugs (NSAIDs) in total. METHODS: An academic detailing programme was delivered to general practitioners (GPs) in two Norwegian cities. The key message was to avoid diclofenac and COX-2 inhibitors and to use naproxen as the NSAID of choice. We analysed prescription data for 12 months before and after the programme to estimate its impact, using interrupted time series to control for underlying trends, and using the rest of Norway as a comparator...
December 31, 2018: European Journal of Clinical Pharmacology
Cristina Colls, Montse Mias, Anna García-Altés
OBJECTIVE: To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. METHOD: Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity...
December 27, 2018: Gaceta Sanitaria
Carolyn I Jacob
Primary hyperhidrosis is a debilitating condition that causes significant distress and financial burden for affected patients, triggering them to seek medical care for their excessive sweating. Once a diagnosis of primary hyperhidrosis has been established, treatment is initiated to help control sweat production and increase quality of life. While there are no current guidelines in the United States for the treatment of primary hyperhidrosis, there are International Hyperhidrosis Society guidelines that clinicians can use...
December 2018: American Journal of Managed Care
F Atienza-Martín, V Barrios, M I Egocheaga, R Hidalgo, N Marín-Montañés, C Ramis
OBJECTIVES: To contribute to the improvement of the process of anticoagulation in patients with nonvalvular atrial fibrillation (NVAF) through awareness and training activities for Primary Care Physicians. MATERIALS AND METHODS: A total of 38 focus groups, sequenced according to an adaptation of the Failure Mode and Effects Analysis (FMEA) method. Each meeting was driven by «brainstorming» methodology. The geographical representation was homogeneous, with a total of 482 national...
December 21, 2018: Semergen
Ezra Hahn, Shao Hui Huang, Ali Hosni, Albiruni Abdul Razak, Robin L Jones, Brendan C Dickson, Erich M Sturgis, Snehal G Patel, Brian O'Sullivan
The tumor, node, metastases (TNM) anatomic staging system plays a pivotal role in cancer care, research, and cancer control activities. Since the first edition of the American Joint Committee on Cancer TNM staging classification published in 1977, soft tissue sarcomas have been staged in an anatomic site agnostic fashion whereby the primary tumor size (T) was categorized as T1 if <=5 cm and T2 if >5 cm; this remained unchanged through the 7th edition of the TNM. However, soft tissue sarcomas of the head and neck (STSHN) usually present smaller than sarcomas of other sites, but carry a disproportionate risk of local recurrence...
February 2019: Clinical and translational radiation oncology
Achim Wöckel, Jasmin Festl, Tanja Stüber, Katharina Brust, Mathias Krockenberger, Peter U Heuschmann, Steffi Jírů-Hillmann, Ute-Susann Albert, Wilfried Budach, Markus Follmann, Wolfgang Janni, Ina Kopp, Rolf Kreienberg, Thorsten Kühn, Thomas Langer, Monika Nothacker, Anton Scharl, Ingrid Schreer, Hartmut Link, Jutta Engel, Tanja Fehm, Joachim Weis, Anja Welt, Anke Steckelberg, Petra Feyer, Klaus König, Andrea Hahne, Traudl Baumgartner, Hans H Kreipe, Wolfram Trudo Knoefel, Michael Denkinger, Sara Brucker, Diana Lüftner, Christian Kubisch, Christina Gerlach, Annette Lebeau, Friederike Siedentopf, Cordula Petersen, Hans Helge Bartsch, Rüdiger Schulz-Wendtland, Markus Hahn, Volker Hanf, Markus Müller-Schimpfle, Ulla Henscher, Renza Roncarati, Alexander Katalinic, Christoph Heitmann, Christoph Honegger, Kerstin Paradies, Vesna Bjelic-Radisic, Friedrich Degenhardt, Frederik Wenz, Oliver Rick, Dieter Hölzel, Matthias Zaiss, Gudrun Kemper, Volker Budach, Carsten Denkert, Bernd Gerber, Hans Tesch, Susanne Hirsmüller, Hans-Peter Sinn, Jürgen Dunst, Karsten Münstedt, Ulrich Bick, Eva Fallenberg, Reina Tholen, Roswita Hung, Freerk Baumann, Matthias W Beckmann, Jens Blohmer, Peter Fasching, Michael P Lux, Nadia Harbeck, Peyman Hadji, Hans Hauner, Sylvia Heywang-Köbrunner, Jens Huober, Jutta Hübner, Christian Jackisch, Sibylle Loibl, Hans-Jürgen Lück, Gunter von Minckwitz, Volker Möbus, Volkmar Müller, Ute Nöthlings, Marcus Schmidt, Rita Schmutzler, Andreas Schneeweiss, Florian Schütz, Elmar Stickeler, Christoph Thomssen, Michael Untch, Simone Wesselmann, Arno Bücker, Andreas Buck, Stephanie Stangl
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature...
November 2018: Geburtshilfe und Frauenheilkunde
Julie Ann Francis, Lua Eiriksson, Erin Dean, Alexandra Sebastianelli, Boris Bahoric, Shannon Salvador
OBJECTIVE: This guideline reviews the clinical evaluation and management of squamous cell cancer (SCC) of the vulva with respect to diagnosis, primary surgical, radiation, or chemotherapy management and need for adjuvant treatment with chemotherapy and/or radiation therapy. Other vulvar cancer pathologic diagnoses are not included in the guideline. INTENDED USERS: The first part of this document which includes recommendations 1 through 3 is for general gynaecologists, obstetricians, family doctors, registered nurses, nurse practitioners, residents, and health care providers with a focus on the presentation, diagnosis, and updated information about surgical procedures performed by subspecialists...
January 2019: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Victor M Lu, Anshit Goyal, Mohammed Ali Alvi, Panagiotis Kerezoudis, Michael G Haddock, Mohamad Bydon
The incidence of extraosseous Ewing's sarcoma, a highly malignant mesenchymal mass, is rare in the spinal cord and its clinical outcomes unknown. To date, few cases of primary intradural extramedullary Ewing's sarcoma (PIEES) have been reported, with varying follow-up. Herein, we aimed to perform a comprehensive review of all cases published in the literature and update previously reported cases from our institution. Institutional medical records were searched for cases of PIEES of the spine managed at our institution between the years 2005 and 2018...
December 14, 2018: Clinical Neurology and Neurosurgery
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