scholarly journals Recognizing Gynecological Cancer in Primary Care: Risk Factors, Red Flags, and Referrals

2018 ◽  
Vol 35 (4) ◽  
pp. 577-589 ◽  
Author(s):  
Garth Funston ◽  
Helena O’Flynn ◽  
Neil A. J. Ryan ◽  
Willie Hamilton ◽  
Emma J. Crosbie
2018 ◽  
Vol 35 (4) ◽  
pp. 590-590
Author(s):  
Garth Funston ◽  
Helena O’Flynn ◽  
Neil A. J. Ryan ◽  
Willie Hamilton ◽  
Emma J. Crosbie

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697277
Author(s):  
James Durrand ◽  
F McHardy ◽  
E Land ◽  
Z Llewellyn ◽  
C Norman ◽  
...  

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poggio Rosana ◽  
Goodarz Danaei ◽  
Laura Gutierrez ◽  
Ana Cavallo ◽  
María Victoria Lopez ◽  
...  

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Palmieri ◽  
S Vannucchi ◽  
C Lo Noce ◽  
A Di Lonardo ◽  
B Unim ◽  
...  

Abstract Background Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population. Methods Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR &lt; 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl). Conclusions Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process. Key messages The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.


CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 167-168
Author(s):  
C. Brendan Montano ◽  
Mehul Patel ◽  
Rakesh Jain ◽  
Prakash S. Masand ◽  
Amanda Harrington ◽  
...  

AbstractIntroductionApproximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.MethodsExisting questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.ResultsA total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.ConclusionThis new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.FundingAbbVie Inc.


2013 ◽  
Vol 21 (1) ◽  
pp. 10-18
Author(s):  
Jennifer S. Funderburk ◽  
Stephen A. Maisto ◽  
Allison K. Labbe

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