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Diagnostic aid to rule out pneumonia in adults with cough and feeling of fever. A validation study in the primary care setting  [cached]
Held Ulrike,Steurer-Stey Claudia,Huber Felix,Dallafior Sergio
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-355
Abstract: Background We recently reported the derivation of a diagnostic aid to rule out pneumonia in adults presenting with new onset of cough or worsening of chronic cough and increased body temperature. The aim of the present investigation was to validate the diagnostic aid in a new sample of primary care patients. Methods From two group practices in Zurich, we included 110 patients with the main symptoms of cough and subjective feeling of increased body temperature, and C-reactive protein levels below 50 μg/ml, no dyspnea, and not daily feeling of increased body temperature since the onset of cough. We excluded patients who were prescribed antibiotics at their first consultation. Approximately two weeks after inclusion, practice assistants contacted the participants by phone and asked four questions regarding the course of their complaints. In particular, they asked whether a prescription of antibiotics or hospitalization had been necessary within the last two weeks. Results In 107 of 110 patients, pneumonia could be ruled out with a high degree of certainty, and no prescription of antibiotics was necessary. Three patients were prescribed antibiotics between the time of inclusion in the study and the phone interview two weeks later. Acute rhinosinusitis was diagnosed in one patient, and antibiotics were prescribed to the other two patients because their symptoms had worsened and their CRP levels increased. Use of the diagnostic aid could have missed these two possible cases of pneumonia. These observations correspond to a false negative rate of 1.8% (95% confidence interval: 0.50%-6.4%). Conclusions This diagnostic aid is helpful to rule out pneumonia in patients from a primary care setting. After further validation application of this aid in daily practice may help to reduce the prescription rate of unnecessary antibiotics in patients with respiratory tract infections.
A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever
Johann Steurer, Ulrike Held, Anne Spaar, Birke Bausch, Marco Zoller, Roger Hunziker, Lucas M Bachmann
BMC Medicine , 2011, DOI: 10.1186/1741-7015-9-56
Abstract: This was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool.A total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5%) of patients. Antibiotics were prescribed to 234 (48.3%) of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI): 6.4 to 11.8).Following validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumoniaRespiratory tract infections are the most frequent reasons for unnecessary antibiotic prescriptions and inappropriate treatment with antibiotics is one of the avoidable causes for the world-wide increasing problem of antibiotic resistance [1-3]. Guidelines [4-6] and patient information leaflets [7] emphasize this serious problem by recommending antibiotics only for patients with bacterial pneumonia and not for patients with acute bronchitis or mild exacerbations of chronic bronchitis [8,9]. The reasons for the still high rate of inappropriate prescriptions in patients with cough and fever are man
Effect of Maternal Indices on Fetal Outcomes in a Primary Health Care Centre  [cached]
E.K. Nwangwa
Asian Journal of Medical Sciences , 2012,
Abstract: It is well known that perinatal and neonatal morbidity and mortality rates are functions of birth weight. In the present study. the effects of maternal indices on the fetal outcome were investigated. A total of Two hundred consenting pregnant mothers who delivered between 2007-2010 in a primary Health Care centre in Delta State, Nigeria were recruited for the study. Those who had chronic ailments or pregnancy complications were excluded from this study. The data collected includes maternal weight. maternal age, gestational age, sex of baby. The result shows a significant (p<0.05) relationship between the mean maternal weight, mean maternal age and mean gestational age with the mean birth weight and also a non significant relationship between the sex of babies with birth weight and gestational length. Therefore, it is advocated that special attention should be given to pregnant women during antenatal care/prenatal care in order to minimize or eliminate the complications associated with low birth weight delivery.
Study on the Construction of the Day Care Centre for the Elderly in Chinese Communities  [cached]
Cross-Cultural Communication , 2011, DOI: 10.3968/2224
Abstract: The functional orientation of constructing the day care centre for the elderly in communities should be providing life care, health care and rehabilitation and consolation services to the elderly that need them. It is required to fix the constructing scale according to the total number of the elderly and the degree of aging. Housing construction must contain houses for life service, health care and rehabilitation, amusement and supplementary house, etc. Key words: Community care; Day care centre for the elderly; Construction
Health Seeking Behaviours of Patients Attending Primary Eye Care Centre in Nigeria
Emmanuel Olu Megbelayin, Yewande Olubunmi Babalola
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1101489
Abstract: Purpose: To determine health seeking behaviour in relation to non-orthodox eye medication use among patients attending a primary eye health center in Nigeria. Materials and Methods: It was a cross-sectional study of consecutive respondents. Participants’ socio-demographic profile, types and pattern of harmful traditional eye medications (HTEMs) use were obtained using a pre-tested questionnaire. Data analysis was by SPSS version 20.0. Results: Of the 303 patients enrolled in the study, 153 (50.5%) were males and 150 (49.5%) were females. The age range was from 13 years old to 94 years old with a mean of 53.8 ± 17.05 years old. Majority of the subjects (74.3%) used orthodox medical outfits for their eye care needs. The prevalence of use of HTEMs was 11.9%. Common forms of TEMs used were herbs 24 (66.7%), sugar water 3 (8.3%), breast milk 3 (8.3%) and onions 6 (16.7%). There was statistically significant association between age and use of HTEMs (p = 604.27, X2=< 0.001, 95% CI = 0.000 - 0.010), and health seeking behaviour (p = 808.70, X2=< 0.001, 95% CI = 0.000 - 0.010). Conclusion: Eye care providers and health care managers must have good knowledge of the various factors that negatively influence utilization of eye care services and be responsive to them.
Quality of Care for Adult Type 2 Diabetes Mellitus at a University Primary Care Centre in Malaysia
Chew Boon How,Khoo Ee Ming,Chia Yook Chin
International Journal of Collaborative Research on Internal Medicine & Public Health , 2011,
Abstract: Background: Type 2 Diabetes Mellitus (T2D) with its concurrent cardiovascular risk factors such as hypertension and dyslipidaemia and its complications has now accounted for the majority of national and global morbidity and mortality.Aims & Objective: The study aimed to determine the prevalence of complications appearing in diabetic patients despite therapy, addressing to an urban academic primary care centre.Methods: This was a sub-analysis of a cross-sectional study on 212 patients with Type 2 diabetes mellitus (T2D) conducted from June to September 2006. Patients aged ≥ 30 years, non-smokers and under follow-up care of senior doctors were recruited. The average of the three most recent readings of fasting plasma sugar, HbA1c, systolic and diastolic blood pressure, and lipid profiles was taken as measures of respective disease control. Results: Two thirds of the patients were female. The mean age was 62.7 (SD± 10.8) years and the duration of T2D was 11.74 (SD± 6.7) years. A total of 23.6% achieved HbA1c ≤ 7.0%, 26.2% attained LDL-C ≤ 2.6 mmol/L and 24.5% achieved target blood pressure < 130/ 80 mmHg. The most prevalent co-morbid condition was hypertension (77.3%). A total of 27.2% patients had diabetic complications, out of which 86.5% had one complication. Proteinuria < 1gm/L and coronary artery disease were the two most common complications. There were only 16% on subcutaneous insulin and this was significantly associated with fasting plasma glucose (t = 5.38, df= 204, p < 0.0001) and HbA1c (t = 4.31, df= 206, p < 0.0001).Conclusions: Many T2D patients at this centre did not achieve treatment goals. Insulin and lipid-lowering drugs use should be optimized to improve control rates. More structured care processes are urgently needed in order to achieve good glycaemic control.
Primary care morbidity in Eastern Cape Province
V Brueton, P Yogeswaran, J Chandia, K Mfenyana, B Modell, M Modell, I Nazareth
South African Medical Journal , 2010,
Abstract: Background. Primary health care in rural South Africa is predominantly provided by remote clinics and health centres. In 1994, health centres were upgraded and new health centres developed to serve as a health care filter between community clinics and district hospitals. Aim. To describe the spectrum of clinical problems encountered at a new health centre in an area of high economic deprivation and compare this with an adjacent community clinic and district hospital. Design. Cross-sectional survey. Setting. A rural clinic, health centre and district hospital in Eastern Cape Province, South Africa. Methods. The International Classification of Primary Care-2 (ICPC-2) was used to code data collected over a 13-week period from patients presenting at a community clinic, health centre and district hospital. Results. Altogether, 4 383 patient encounters were recorded across all three sites. Most contacts at the clinic (97%) and the health centre (80%) were with a nurse. Females over 15 years of age comprised over half of all contacts at health facilities (53%). The most common diagnosis category was respiratory (23%). Cough was the most common symptom. Thirty per cent of children up to 5 years of age were seen for immunisations. Most childhood immunisations (79%) were carried out at the health centre. Conclusion. Of all the health care facilities surveyed, the health centre had the highest throughput of patients, indicating that the health centre is an efficient filter between the community and hospital. The ICPC-2 can be successfully used to monitor encounters at similar African health care facilities. S Afr Med J 2010; 100: 309-312.
Helicobacter pylori related dyspepsia: prevalence and treatment outcomes at University Kebangsaan Malaysia-Primary Care Centre
Aznida Abdul Aziz, Zuhra Hamzah, Seng Fah Tong, Sukumar Nadeson, Sharifa Wan Puteh
Asia Pacific Family Medicine , 2009, DOI: 10.1186/1447-056x-8-4
Abstract: A total of 98 patients completed Modified Glasgow Dyspepsia Severity Score Questionnaire (MGDSSQ) at initial presentation before undergoing the 13Carbon Urea Breath Test (UBT) for HP. Those with positive UBT received Eradication Therapy with oral Omeprazole 20 mg twice daily, Clarithromycin 500 mg daily and Amoxycillin 500 mg twice daily for one week followed by Omeprazole to be completed for another 4 to 6 weeks. Those with negative UBT received empirical treatment with oral Omeprazole 20 mg twice daily for 4 to 6 weeks. Patients were assessed again using the MGDSSQ at the completion of treatment and one month after stopping treatment.The prevalence of dyspepsia at Universiti Kebangsaan Malaysia-Primary Care Centre was 1.12% (124/11037), out of which 23.5% (23/98) was due to HP. Post treatment assessment in both HP (95.7%, 22/23) and non HP-related dyspepsia (86.7%, 65/75) groups showed complete or almost complete resolution of dyspepsia. Only about 4.3% (1/23) in the HP related dyspepsia and 13.3% (10/75) in the non HP group required endoscopy.The prevalence of dyspepsia due to HP in this primary care centre was 23.5%. Detection of HP related dyspepsia yielded good treatment outcomes (95.7%).Dyspepsia is described as chronic or recurrent pain or discomfort in the upper abdomen. The prevalence of dyspepsia in western countries is approximately 25% which accounts for 2–5% of primary care consultations [1,2]. One of the challenges in treating dyspepsia for primary care physicians is to determine the optimal treatment for the patient presenting with new onset or previously uninvestigated dyspeptic symptoms [3].Dyspepsia could be due to several causes such as peptic ulcer disease, reflux disease, drugs (especially Non-Steroidal Anti-Inflammatory Drugs, NSAIDs) and idiopathic. Symptoms commonly overlap, making diagnosis difficult. Gastro-oesophageal reflux disease (GORD) presents with predominant or frequent (more than once a week) heartburn or acid regurgitation [4]. H
Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study
Ranja Str?mberg, Lars G Backlund, Monica L?fvander
BMC Family Practice , 2011, DOI: 10.1186/1471-2296-12-120
Abstract: Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.Depression is a frequent disorder and thus also a common health problem to deal with in primary care [1-4]. The economic burden of depression in Sweden has doubled in the past decade owing to costs associated with reduced ability to work [5]. Worldwide, depression is one of the leading causes of ill health and disability, a trend that is likely to increase [6].According to a meta-analysis, people with low soci
Reasons why patients with primary health care problems access a secondary hospital emergency centre
J Becker, A Dell, L Jenkins, R Sayed
South African Medical Journal , 2012,
Abstract: Background. Many patients present to an emergency centre (EC) with problems that could be managed at primary healthcare (PHC) level. This has been noted at George Provincial Hospital in the Western Cape province of South Africa. Aim. In order to improve service delivery, we aimed to determine the patient-specific reasons for accessing the hospital EC with PHC problems. Methods. A descriptive study using a validated questionnaire to determine reasons for accessing the EC was conducted among 277 patients who were triaged as green (routine care), using the South African Triage Score. The duration of the complaint, referral source and appropriateness of referral were recorded. Results. Of the cases 88.2% were self-referred and 30.2% had complaints persisting for more than a month. Only 4.7% of self-referred green cases were appropriate for the EC. The three most common reasons for attending the EC were that the clinic medicine was not helping (27.5%), a perception that the treatment at the hospital is superior (23.7%), and that there was no PHC service after-hours (22%). Conclusions. Increased acceptability of the PHC services is needed. The current triage system must be adapted to allow channelling of PHC patients to the appropriate level of care. Strict referral guidelines are needed.
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