August 31st, 2007
Clinical diagnosis of herpes zoster in family practice.
Ann Fam Med. 2007 Jul-Aug;5(4):305-9
Authors: Opstelten W, van Loon AM, Schuller M, van Wijck AJ, van Essen GA, Moons KG, Verheij TJ
PURPOSE: Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians’ judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice. METHODS: Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confirmation of herpes zoster. RESULTS: Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confirmed serologically (positive predictive value of clinical judgment 90.8%; 95% confidence interval, 87.3%-94.3%). Independent clinical variables for serologically confirmed herpes zoster were severity and duration of rash at first examination. CONCLUSION: Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster.
PMID: 17664496 [PubMed - in process]
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Posted by Emma
August 31st, 2007
A pragmatic approach to the primary care management of men with lower urinary tract symptoms.
Int J Clin Pract. 2007 Sep;61(9):1423-5
Authors: Chapple CR, Patel AK
PMID: 17686085 [PubMed - in process]
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Posted by Jessica
August 31st, 2007
A prediction rule for elderly primary-care patients with lower respiratory tract infections.
Eur Respir J. 2007 May;29(5):969-75
Authors: Bont J, Hak E, Hoes AW, Schipper M, Schellevis FG, Verheij TJ
Prognostic scores for lower respiratory tract infections (LRTI) have been mainly derived in a hospital setting. The current authors have developed and validated a prediction rule for the prognosis of acute LRTI in elderly primary-care patients. Data including demographics, medication use, healthcare use and comorbid conditions from 3,166 episodes of patients aged > or =65 yrs visiting the general practitioner (GP) with LRTI were collected. Multiple logistic regression analysis was used to construct a predictive model. The main outcome measure was 30-day hospitalisation or death. The Second Dutch Survey of GPs was used for validation. The following were independent predictors of 30-day hospitalisation or death: increasing age; previous hospitalisation; heart failure; diabetes; use of oral glucocorticoids; previous use of antibiotics; a diagnosis of pneumonia; and exacerbation of chronic obstructive pulmonary disease. A prediction rule based on these variables showed that the outcome increased directly with increasing scores: 3, 10 and 31% for scores of <2 points, 3-6 and > or =7 points, respectively. Corresponding figures for the validation cohort were 3, 11 and 26%, respectively. This simple prediction rule can help the primary-care physician to differentiate between high- and low-risk patients. As a possible consequence, low-risk patients may be suitable for home treatment, whereas high-risk patients might be monitored more closely in a homecare or hospital setting. Future studies should assess whether information on signs and symptoms can further improve this prediction rule.
PMID: 17215313 [PubMed - indexed for MEDLINE]
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Posted by Williams
