Detection of dementia

Detection of dementia is usually a two-step procedure, consisting of screening and application of diagnostic instruments. Screening has to be done on the background of fears for stigma and loss of autonomy.There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. We present results of a study in primary care, where we tested which elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…) would be best for this age group. All available screenings showed a good effect size of >0.70.For the application of further diagnostic tools an update of the current guidelines is given and compared to the available evidence regarding guideline implementation. As far as possible, results of an ongoing study in Switzerland will be presented.

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Assessment of impact of ARIA guideline implementation vs routine care on rhinitis related quality of life in a primary care setting in Ireland

10.26226/morressier.5acc8ad0d462b8028d89ab27 ◽

2018 ◽

Author(s):

Anne Marie McGinley

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Guideline Implementation ◽

Routine Care ◽

Related Quality

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Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000452485 ◽

2016 ◽

Vol 43 (1-2) ◽

pp. 15-28 ◽

Cited By ~ 5

Author(s):

Ilka M. Rosa ◽

Ana Gabriela Henriques ◽

Liliana Carvalho ◽

Joana Oliveira ◽

Odete A.B. da Cruz e Silva

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Gastrointestinal Disease ◽

Gastrointestinal Diseases ◽

Diagnostic Tools ◽

Clinical Dementia Rating ◽

Dementia Prevalence ◽

Dementia Screening ◽

Primary Care Settings

Background/Aims: Diagnosing dementia is challenging in many primary care settings, given the limited human resources and the lack of current diagnostic tools. With this in mind, a primary care-based cohort was established in the Aveiro district of Portugal. Methods: A total of 568 participants were evaluated using cognitive tests and APOE genotyping. Results: The findings revealed a dementia prevalence of 12%. A strong correlation between increasing Clinical Dementia Rating (CDR) scores and education was clearly evident. Other highly relevant risk factors were activities of daily living (ADL), instrumental ADL, aging, depression, gender, the APOE ε4 allele, and comorbidities (depression as well as gastrointestinal, osteoarticular, and neurodegenerative diseases). A hitherto unreported, significant correlation between gastrointestinal disease and high CDR score was clearly observable. Conclusions: This study shows the merit of carrying out a dementia screening on younger subjects. Significantly, 71 subjects in the age group of 50-65 years were flagged for follow-up studies; furthermore, these cases with a potentially early onset of dementia were identified in a primary care setting.

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Facilitating Guideline Implementation in Primary Health Care Practices

Journal of Primary Care & Community Health ◽

10.1177/2150132720916263 ◽

2020 ◽

Vol 11 ◽

pp. 215013272091626

Author(s):

Sanne Peters ◽

André Bussières ◽

Bart Depreitere ◽

Stijn Vanholle ◽

Julie Cristens ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Health Professionals ◽

Health Care Professionals ◽

Care Setting ◽

Primary Care Setting ◽

Guideline Implementation ◽

Multidisciplinary Teams ◽

Primary Health ◽

Care Practices

Introduction: Many patients continue to receive suboptimal services, inappropriate, unsafe, and costly care. Underutilization of research by health professionals is a common problem in the primary care setting. Although many theoretical frameworks can be used to help address such evidence-practice gaps, health care professionals may not be aware of the benefits of frameworks or of the most appropriate ones for their context and thus, may be faced with the challenge of selecting and using the most relevant one. Aim: The aim of this article was to describe the process used to adapt a knowledge translation framework to meet the local needs of health professionals working in one large primary care setting. Methods: The authors developed a 5-step approach for guideline implementation. This approach was informed by prior research and the authors’ experiences in supporting multidisciplinary teams of health care professionals during the implementation of evidence-based clinical guidelines into primary care practices. To ensure that the 5-step approach was practical and suitable for the context of guideline implementation by multidisciplinary teams in primary health care, the implementation team adapted the “knowledge-to-action” framework using a multistep process. Results: The implementation approach consisted of the following 5 steps: identification, context analysis, development of implementation plan, evaluation, and sustainability. All 5 steps were described alongside details about a national low back pain project. Discussion: This article describes a collaborative, grassroots process that addressed an identified need in one complex context by adapting a knowledge translation framework to meet the local needs of health professionals working in primary care settings. Existing implementation frameworks may be too complex or abstract for use in busy clinical contexts. The 5-step approach presented in this paper resulted in practical steps that are more readily understood by health care professionals and staff on “the ground.”

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Diagnosing Constipation Spectrum Disorders in a Primary Care Setting

Journal of Clinical Medicine ◽

10.3390/jcm10051092 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1092

Author(s):

Joel Heidelbaugh ◽

Nicole Martinez de Andino ◽

David Pineles ◽

David Poppers

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Care Setting ◽

Primary Care Setting ◽

Physical Therapist ◽

Diagnostic Tools ◽

Slow Transit Constipation ◽

Idiopathic Constipation ◽

Detailed Medical History ◽

Alarm Features

Understanding pathophysiological causes of constipation is worthwhile in directing therapy and improving symptoms. This review aims to identify and fill gaps in the understanding of the pathophysiology of constipation, understand its prevalence, review diagnostic tools available to primary care physicians (PCPs), and highlight patients’ expectations for the management of this common spectrum of disorders. Literature searches conducted via PubMed included terms related to constipation, diagnosis, and patient perceptions. Case studies were developed to highlight the differences between patients who may be appropriately managed in the primary care setting and those requiring specialty consultation. Myriad pathophysiological factors may contribute to constipation, including stool consistency, altered intestinal motility, gut microbiome, anorectal abnormalities, as well as behavioral and psychological factors. Common diagnoses of “primary constipation” include slow-transit constipation, defecation disorders, irritable bowel syndrome with constipation, and chronic idiopathic constipation. A detailed medical history should be conducted to exclude alarm features and PCPs should be familiar with pathophysiological factors that cause constipation, available diagnostic tools, alarm signs, and the various classification criteria for constipation subtypes in order to diagnose and treat patients accordingly. PCPs should understand when a referral to a gastroenterologist, anorectal specialist, pelvic floor physical therapist, and/or mental health specialist is appropriate.

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