Family Medicine Update

Best practice in primary care pathology: review 11.

J Clin Pathol. 2007 Oct 26;

Authors: Smellie WS, Vanderpump MP, Fraser WD, Bowley R, Shaw N

This eleventh best practice review examines two series of common primary care questions in laboratory medicine: (i) thyroid testing, and (ii) hypercalcaemia and hypocalcaemia. The review is presented in the same question-answer format as previously, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. In the case of the thyroid series, the recommendations are drawn from the 2006 guidelines published by the Association for Clinical Biochemistry, British Thyroid Association and the British Thyroid Foundation. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 17965216 [PubMed - as supplied by publisher]

  more…

[Bach pain in primary care: a changing paradigm over time]

Rev Med Suisse. 2007 Sep 26;3(126):2152-6

Authors: Rueff-Cacitti K, Steiner AS, Sacroug T, Bovier PA

Acute lumbar pain is a frequent problem in primary care. Specific problems can be easily ruled out based on personal history and clinical examination in the absence of the so called “red flags”. The primary care doctor must then avoid to prescribe any unnecessary additional test, but emphasize the “functional” nature of the problem and the absence of organic lesions. Reassurance and prompt mobilization are key elements for a quick recovery. When lumbar pain becomes chronic, a therapeutic agenda based only on the biomedical model will fail, because causative organic lesions are generally absent. Instead, the bio-psychosocial approach can help to reestablish a favourable doctor-patient relationship, which integrates an active participation of the patient to establish common therapeutic goals.

PMID: 17969731 [PubMed - in process]

  more…

Management of acute diarrhoea in primary care in Bahrain: self-reported practices of doctors.

J Health Popul Nutr. 2007 Jun;25(2):205-11

Authors: Ismaeel AY, Al Khaja KA, Damanhori AH, Sequeira RP, Botta GA

This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August-30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system.

PMID: 17985822 [PubMed - in process]

  more…