scholarly journals Diagnosing OSA in primary care: The utility of clinical judgement, screening questionnaires and portable monitoring

Respirology ◽  
2021 ◽  
Vol 26 (10) ◽  
pp. 908-909
Author(s):  
Ching Li Chai‐Coetzer ◽  
Peter R Eastwood
Keyword(s):  
Primary Care ◽  
Clinical Judgement ◽  
Portable Monitoring ◽  
Screening Questionnaires

scholarly journals The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

2016 ◽  
Vol 20 (51) ◽  
pp. 1-294 ◽  
Author(s):  
Alastair D Hay ◽  
Kate Birnie ◽  
John Busby ◽  
Brendan Delaney ◽  
Harriet Downing ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Cost Effectiveness ◽  
Tract Infection ◽  
Young Children ◽  
Clinical Diagnosis ◽  
Antibiotic Treatment ◽  
Clinical Judgement ◽  
Index Tests

BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

Screening questionnaires to identify problem drinking in the primary care setting: a systematic review

2015 ◽  
Vol 24 (1) ◽  
pp. 9-19 ◽  
Author(s):  
Gerhard Mueller ◽  
Petra Schumacher ◽  
Jutta Wetzlmair ◽  
Martin Pallauf
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Problem Drinking ◽  
Screening Questionnaires

scholarly journals Patient beliefs and attitudes towards the acceptability of receiving alcohol use enquiry from general practitioners: a literature review

2014 ◽  
Author(s):  
Louis Leong ◽  
Chun Wah Michael Tam
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
General Practitioners ◽  
Lifestyle Advice ◽  
Patient Beliefs ◽  
Medical Databases ◽  
Screening Questionnaires ◽  
The Uk ◽  
Beliefs And Attitudes ◽  
Realist Perspective

Background: Routine use of alcohol screening questionnaires is recommended in primary care, but patient beliefs and attitudes towards the acceptability of receiving alcohol enquiry from general practitioners (GPs) are unclear. Methods: We searched medical databases to identify published empirical research on patient beliefs, attitudes and experiences towards receiving alcohol discussions from GPs. Coherent themes were synthesised from the results of the included studies using a realist perspective. Seventeen studies were included in the review – the majority were quantitative surveys from the UK, Nordic countries, North America and Australia. Results and Discussion: GPs are seen to be legitimate providers of lifestyle advice, but patients may not find alcohol enquiry acceptable in a specific consultation. Alcohol discussions are less acceptable than those on other health promotion topics. The context of the consultation, such as the reason for presenting and the patient-doctor relationship, has an important influence on the situational acceptability of alcohol enquiry. Conclusion: Although GP involvement in health promotion is perceived as legitimate, alcohol enquiry in consultations can be fraught and unwelcome. Contextual factors pertaining to the consultation appear to be important but these have not been well explored in the literature. Conclusions from this review should be restricted to societies with “Temperance” drinking cultures.

scholarly journals Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people

2017 ◽  
Author(s):  
Sam T Creavin ◽  
Anna H Noel-Storr ◽  
Edo Richard ◽  
Alexandra L Creavin ◽  
Sarah Cullum ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Primary Care Physicians ◽  
Clinical Judgement

scholarly journals Validity of brief screening questionnaires to detect depression in primary care in Ethiopia

2015 ◽  
Vol 186 ◽  
pp. 32-39 ◽  
Author(s):  
Charlotte Hanlon ◽  
Girmay Medhin ◽  
Medhin Selamu ◽  
Erica Breuer ◽  
Benyam Worku ◽  
...  
Keyword(s):  
Primary Care ◽  
Screening Questionnaires ◽  
Brief Screening

Caregiver Comfort, Concerns, and Involvement in Adolescents Independently Completing Screening Questionnaires at Primary Care Visits

2018 ◽  
Vol 62 (2) ◽  
pp. S92
Author(s):  
Stephanie N. Ferrin ◽  
Randall W. Grout ◽  
Amy L. Gilbert ◽  
Tracey A. Wilkinson ◽  
Stephen M. Downs ◽  
...  
Keyword(s):  
Primary Care ◽  
Screening Questionnaires

Comparison of three clinical screening questionnaires for Sleep Apnea Syndrome (SAS) in Primary Care (PC)

2018 ◽  
Author(s):  
Patricia Peñacoba ◽  
Mª Antonia Llauger ◽  
Rosa Mª Miralda ◽  
Leandra Domínguez ◽  
Ana Mª Fortuna ◽  
...  
Keyword(s):  
Primary Care ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Clinical Screening ◽  
Screening Questionnaires ◽  
Apnea Syndrome

scholarly journals The Precision of Screening Questionnaires for Diabetes Mellitus Type 2 and Hypertension Compared with the Gold Standard in Primary Care

2018 ◽  
Vol 1 (2) ◽  
pp. 75
Author(s):  
Seta Nurhayati Mularum ◽  
Hari Kusnanto ◽  
Wahyudi Istiono
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Risk Factor ◽  
Gold Standard ◽  
Primary Care Physicians ◽  
Independent Risk Factor ◽  
Abdominal Circumference ◽  
Health Coverage ◽  
Screening Questionnaires ◽  
History Of

Background: Diabetes mellitus (DM) and hypertension are health issues that are the focus of the Indonesian government, especially in the era of Universal Health Coverage/Jaminan Kesehatan Nasional (JKN). The prevalences have been steadily increasing daily. Special Region of Yogyakarta (DIY) has the highest prevalence of DM in Indonesia, while hypertension prevalence is 25.7% according to data from Riskesdas 2013. Complications from diabetes and hypertension lead to decreased quality of life and premature death, therefore it is necessary to have a better management strategy to reduce the risks. Nowadays, there are no diabetes and hypertension screening questionnaires which have been validated and implemented in the district of Bantul. Therefore, it is important to develop screening questionnaires for early detection of diabetes and hypertension as a tool for primary care physicians to perform tasks at the preventive level.Objective: This study aimed to measure the accuracy of screening questionnaires to detect diabetes mellitus and hypertension in primary care in Bantul DIY.Methods: This study used a cross-sectional method. The subjects of the study were a group of individuals aged 40-60 years in Bantul who met the criteria inclusion and the criteria exclusion. The study subjects were asked to complete the screening questionnaires of diabetes and hypertension. The results were then compared with the gold standard of fasting blood sugar and blood pressure check. The data were analyzed by using multivariate regression tests.Results: The results of multivariate analysis showed that the risk factors were a history of baby born weight ≥ 4 kg or gestational diabetes mellitus and the abdominal circumference was an independent risk factor for the incidence of diabetes in general population. Being a baby born with weight ≥ 4 kg and abdominal circumference had p = 0.001: RR 2.75 (CI 95%: 1.5 to 5.0) and p = 0.036: RR of 8.08 (CI 95%: 1.15 to 56.8), respectively. The risk factor of age was an independent risk factor for hypertension with p = 0.003: RR of 3.1 (CI 95%: 1.4 to 6.6).Conclusion: History of a baby born with weight ≥ 4 kg and abdominal circumference were appropriate for screening DM, meanwhile the age was appropriate for screening hypertension.

scholarly journals Detecting sleep apnoea syndrome in primary care with screening questionnaires and the Epworth sleepiness scale

2019 ◽  
Vol 211 (2) ◽  
pp. 65-70 ◽  
Author(s):  
Chamara V Senaratna ◽  
Jennifer L Perret ◽  
Adrian Lowe ◽  
Gayan Bowatte ◽  
Michael J Abramson ◽  
...  
Keyword(s):  
Primary Care ◽  
Epworth Sleepiness Scale ◽  
Sleep Apnoea ◽  
Sleep Apnoea Syndrome ◽  
Screening Questionnaires
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