Pediatric hallux valgus: An overview of history, examination, conservative, and surgical management

2021 ◽  
Author(s):  
Alexandra H Seidenstein ◽  
Timothy W Torrez ◽  
Nicholas A Andrews ◽  
David A Patch ◽  
Michael J Conklin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Surgical Management ◽  
Skeletal Maturity ◽  
Primary Care Providers ◽  
Care Providers ◽  
Connective Tissues ◽  
First Line ◽  
Pediatric Age Group ◽  
Open Physis ◽  
Associated Conditions

Abstract Pediatric hallux valgus (PHV), while relatively rare, is still often encountered by general pediatricians. Herein, we concisely summarize the existing literature regarding the pathogenesis, associated conditions, clinical diagnosis, radiographic characteristics, conservative management, and surgical management of PVH. Though PHV is generally considered benign, the progression of hallux valgus can result in complications. The presence of an open physis in the pediatric age group delineates first line treatment choices, whenever possible, as nonoperative. The general exception to this recommendation is for children with neuromuscular and connective tissues disease who may benefit from earlier surgical management. If conservative approaches fail prior to skeletal maturity, the risk of recurrence and need for revision surgery should be discussed with patients and their families before surgical referral is made. The current review was conducted to aid primary care providers in better understanding the pathogenesis, associated conditions, and intervention options available to manage PHV.

Management of Common Breastfeeding Problems

2017 ◽  
Vol 8 (4) ◽  
pp. 181-188 ◽  
Author(s):  
Tipu V. Khan ◽  
Michael Ramirez
Keyword(s):  
Support Group ◽  
Primary Care Providers ◽  
Care Providers ◽  
First Line ◽  
Team Care ◽  
Department Of Health ◽  
Care Approach ◽  
Healthy People 2020 ◽  
La Leche League ◽  
Breastfeeding Problems

The U.S. Department of Health and Human Services Healthy People 2020 goal is to achieve a rate of breastfeeding at 12 months of age of 34.1%. Primary care providers are the first line in breastfeeding—from prenatal nipple evaluations to identifying and treating complications early. Breastfeeding conveys numerous benefits for both infant and mother. Currently, 77% of women attempt breastfeeding, but only 16% are still breastfeeding at 12 months of age. One of the top reasons for failure is lack of provider support when faced with breastfeeding problems. When the diagnosis is missed, complications can include hospitalization and cessation of breastfeeding. Understanding and being able to manage complications as well as having a team care approach involving an IBCLC and support group, such as La Leche League, are crucial in ensuring breastfeeding success.

Screening for Depression in Primary Care: Can It Become More Efficient?

2009 ◽  
Author(s):  
Kathryn M. Magruder ◽  
Derik E. Yeager
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
First Line ◽  
Preventive Mental Health ◽  
Recommended Services

Screening for depression has been so widely advocated that the burden of proof has shifted to skeptics who argue against it. Yet only recently has sufficient evidence accrued to judge dispassionately the advantages and disadvantages of screening. Here we discuss the evidence for specific tools and specific strategies in improving the outcome of depression screening in primary care. In 1978, the Institute of Medicine defined primary care as ‘‘care that is accessible, comprehensive, coordinated, continuous, and accountable.’’ While the definition has evolved over time,2 these fundamental characteristics are still valid today. Included in the primary care mission is to serve as the first line for detection and either treatment or referral of common mental disorders, including depression. The inclusion of first-line mental health services as a component of primary care distinguishes primary care (including outpatient clinics in managed care organizations, community hospitals, Veterans Administration hospitals, teaching institutions, and other medical centers) from care in more specialized clinical settings. The comprehensiveness of primary care and the obligation of its providers for first-line care make it a logical and appropriate venue for mental health screening. Complicating the issue, however, are the time constraints on primary care providers. Although the amount of time spent per patient visit is about 20 minutes in the United States, the recommended services that should be provided in that short period of time are daunting. It is therefore imperative that these recommended services—in particular preventive health services— be provided in the most efficient manner possible. Services that cannot be provided efficiently and fit within the busy, fast-paced world of primary care are at risk of being omitted. This is especially true for preventive mental health services. Screening for depression is such a service; therefore, it is critical that primary care providers make use of the best and most efficient depression screening approaches possible. In this chapter, we will address issues related to screening for depression in the primary care context. We will start by briefly reviewing the epidemiology of depression as related to primary care. Next, we will provide a critical examination of the applicability to depression screening of the World Health Organization’s criteria.

Surgical management of Charcot neuroarthropathy

2015 ◽  
Vol 39 (1) ◽  
pp. 61-72 ◽  
Author(s):  
Osaretin B Idusuyi
Keyword(s):  
Surgical Management ◽  
Late Complication ◽  
Primary Care Providers ◽  
Fracture Dislocation ◽  
Rational Approach ◽  
Diabetic Patients ◽  
Rapid Progression ◽  
Care Providers ◽  
Charcot Neuroarthropathy ◽  
Diagnosis And Management

Background: Charcot neuroarthropathy is one of the more devastating complications of diabetes. It is a progressive, destructive condition that is characterized by acute fracture, dislocation, and joint destruction in weight-bearing neuropathic foot. In its acute phase, it is often misdiagnosed and can lead to several deformities such as ulcerations and amputation. Early diagnosis and management is, therefore, imperative to avoid rapid progression. Objectives: Review current literature on the diagnosis and management of diabetic patients with Charcot neuroarthropathy. Study design: Narrative review. Methods: Particular attention is directed to the role of surgical management in achieving long term osseous stability and alignment so that appropriate footwear and bracing are possible. Conclusion: Charcot neuroarthropathy is a serious and potentially limb-threatening lower extremity late complication of diabetes. Correct timing, adequate fixation and a long post-operative weightbearing period are key to optimizing reconstructive surgery. Clinical relevance Primary care providers who treat diabetic patients should be cognizant of the possible complication among patients with diabetic neuropathy of which includes Charcot neuroarthropathy. In this paper, discussion is provided on a rational approach to functional limb salvage with various surgical techniques when non-operative management fails.

scholarly journals Helicobacter Pylori: A comprehensive review for primary care providers

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Alfred Nelson ◽  
Yan Bi ◽  
Dana Harris
Keyword(s):  
Primary Care ◽  
Helicobacter Pylori ◽  
Primary Care Providers ◽  
Care Providers ◽  
First Line ◽  
Gastrointestinal Complications ◽  
Comprehensive Review ◽  
Gastric Intestinal Metaplasia ◽  
Primary Care Clinics ◽  
Different Parts

AbstractHelicobacter pylori is the most prevalent bacteria infecting humans resulting in variety of gastrointestinal and extra gastrointestinal complications. Although most of the infected adults are asymptomatic, the prevalence varies in different parts of the world it is higher in Eastern and Southern Europe. Eradication of Helicobacter pylori is necessary to prevent precancerous conditions like gastric atrophy, gastric intestinal metaplasia and gastric dysplasia. This comprehensive review addresses briefly on: whom and how to test and treat including recommended first line therapies, salvage therapies, testing for eradication and strategy to be used in primary care clinics.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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