scholarly journals Physical Manipulation-Induced Femoral Neck Fracture: A Case Report

2020 ◽  
pp. 118-122
Author(s):  
Rami A. Ayoubi ◽  
Nour S. Nassour ◽  
Elias G. Saidy ◽  
Dany K. Aouad ◽  
Joseph S. Maalouly ◽  
...  
Keyword(s):  
Primary Care ◽  
Hip Fracture ◽  
Primary Care Physicians ◽  
Treatment Modalities ◽  
Cerebrovascular Accidents ◽  
Neck Fracture ◽  
History Of ◽  
Hemi Arthroplasty ◽  
History Of Parkinson’S Disease ◽  
Physical Manipulation

Manipulative treatments for pain are very widely used nowadays by a variety of physicians. These treatment modalities are generally safe, but various studies have reported serious complications. This report presents the case of a 78-year-old male patient with a history of Parkinson’s disease, who was diagnosed with a right hip fracture that occurred as a result of physical manipulative treatment. He underwent a cemented hemi-arthroplasty as appropriate surgical treatment of his condition. Manipulative treatments can result in minor and major complications ranging from simple sprains and rib fractures to cerebrovascular accidents and death. The frequency of these events seems to be rare; however, no robust studies are present and further investigations are urgently needed. Hip fractures as a result of this treatment have not been previously mentioned. This is the first reported case in the literature of a hip fracture resulting from manipulative treatment. Primary care physicians and orthopedists should be aware of the possibility of this outcome and rule it out whenever necessary.

scholarly journals A Review of Recent Advances in the Diagnosis and Treatment Modalities for Long Head of Bicep Tendinopathy

2016 ◽  
Vol 7 ◽  
pp. CMTIM.S39404 ◽  
Author(s):  
Robert B. Lewis ◽  
Bryan A. Reyes ◽  
Michael S. Khazzam
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Recent Literature ◽  
Biceps Tendon ◽  
Treatment Options ◽  
Diagnostic Methods ◽  
Treatment Modalities ◽  
Orthopedic Surgeons ◽  
History Of ◽  
Long Head

This article reviews the assessment and management of the pathology of the long head of the biceps tendon, a disease commonly encountered by primary care physicians and orthopedic surgeons. We include a discussion of relevant anatomy, function, pathoanatomy, natural history of the disease, diagnostic methods, and treatment options. Recent literature on the function of the long head of the bicep (LHB) is reviewed. Literature on our evolving understanding of the pathoanatomy behind LHB tendinopathy is discussed. We also discuss the effectiveness of current diagnostic and treatment modalities.

scholarly journals The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fatima Cody Stanford ◽  
Erica D. Johnson ◽  
Mechelle D. Claridy ◽  
Rebecca L. Earle ◽  
Lee M. Kaplan
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Medical School ◽  
Primary Care Physicians ◽  
Massachusetts General Hospital ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Survey Respondent ◽  
Healthy Weight ◽  
Cross Sectional

Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

scholarly journals UNDERSTANDING OSTEOPOROSIS SCREENING PRACTICES IN MEN: A NATIONWIDE PHYSICIAN SURVEY

2020 ◽  
Vol 26 (11) ◽  
pp. 1237-1243
Author(s):  
Palak Choksi ◽  
Brittany L. Gay ◽  
David Reyes-Gastelum ◽  
Megan R. Haymart ◽  
Maria Papaleontiou
Keyword(s):  
Primary Care ◽  
Confidence Interval ◽  
Primary Care Physicians ◽  
Menopausal Woman ◽  
Significant Past Medical History ◽  
Endocrine Society ◽  
Osteoporosis Screening ◽  
Screening Practices ◽  
Clinical Scenarios ◽  
History Of

Objective: To understand osteoporosis screening practices, particularly in men, by a diverse cohort of physicians, including primary care physicians, endocrinologists, and geriatricians. Methods: We surveyed randomly selected members of the American Academy of Family Practice, Endocrine Society, and American Geriatrics Society. Respondents were asked to rate how often they would screen for osteoporosis in four different clinical scenarios by ordering a bone density scan. Multivariable logistic regression analyses were conducted to determine factors associated with offering osteoporosis screening in men in each clinical scenario. Physicians were also asked to note factors that would lead to osteoporosis screening in men. Results: Response rate was 63% (359/566). While 90% respondents reported that they would always or frequently screen for osteoporosis in a 65-year-old post-menopausal woman, only 22% reported they would screen a 74-year-old man with no significant past medical history. Endocrinologists were more likely to screen a 74-year-old man compared to primary care physicians (odds ratio, 2.32; 95% confidence interval, 1.10 to 4.88). In addition to chronic steroid use (94%), history of nontraumatic fractures (88%), and androgen-deprivation therapy for prostate cancer (82%), more than half the physicians reported suppressive doses of thyroid hormone (64%) and history of falls (52%) as factors leading to screening for osteoporosis in men. Conclusion: Our survey results highlight heterogeneity in osteoporosis screening in men, with underscreening in some scenarios compared to women, and identify factors that lead to screening in men. These findings can help design interventions to improve osteoporosis screening in men. Abbreviation: CI = confidence interval

scholarly journals Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030346
Author(s):  
Nina Julie Verket ◽  
Ragnhild Sørum Falk ◽  
Erik Qvigstad ◽  
Tom Gunnar Tanbo ◽  
Leiv Sandvik
Keyword(s):  
Primary Care ◽  
Family History ◽  
High Risk ◽  
Prediction Model ◽  
Early Identification ◽  
Primary Care Physicians ◽  
Lasso Regression ◽  
Cross Sectional ◽  
Predictive Values ◽  
History Of

ObjectivesTo identify predictors of disease among a few factors commonly associated with endometriosis and if successful, to combine these to develop a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis.DesignCross-sectional anonymous postal questionnaire study.SettingWomen aged 18–45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway.Participants157 women with and 156 women without endometriosis.Main outcome measuresLogistic and least absolute shrinkage and selection operator (LASSO) regression analyses were performed with endometriosis as dependent variable. Predictors were identified and combined to develop a prediction model. The predictive ability of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and positive predictive values (PPVs) and negative predictive values (NPVs). To take into account the likelihood of skewed representativeness of the patient sample towards high symptom burden, we considered the hypothetical prevalences of endometriosis in the general population 0.1%, 0.5%, 1% and 2%.ResultsThe predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. The model based on logistic regression (AUC 0.83) included these two predictors only, while the model based on LASSO regression (AUC 0.85) included two more: severe dysmenorrhea in adolescence and use of painkillers due to dysmenorrhea in adolescence. For the prevalences 0.1%, 0.5%, 1% and 2%, both models ascertained endometriosis with PPV equal to 2.0%, 9.4%, 17.2% and 29.6%, respectively. NPV was at least 98% for all values considered.ConclusionsExternal validation is needed before model implementation. Meanwhile, endometriosis should be considered a differential diagnosis in women with frequent absenteeism from school or work due to painful menstruations and positive family history of endometriosis.

scholarly journals Review on Assessment and Evaluation of Vitiligo in Primary Care

2021 ◽  
pp. 275-283
Author(s):  
Faisal Suliman Algaows ◽  
Tala Shawkat Bukhari ◽  
Tahani Mohammed Asiri ◽  
Abdulkarim Mudbigh Almazyadi ◽  
Salma Abdul Khahar ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Multidisciplinary Approach ◽  
Calcineurin Inhibitors ◽  
Treatment Method ◽  
Treatment Modalities ◽  
Assessment And Evaluation ◽  
Primary Care Settings ◽  
Collaboration And Communication

Vitiligo is an acquired skin disorder characterised by the disappearance of melanocytes, resulting in well-defined white patches that are frequently symmetrically distributed. The lack of melanin pigment makes the lesional skin more sensitive to sunburn. Vitiligo can be cosmetically disfiguring, and it is a stigmatising condition that can lead to serious psychologic problems in daily life. Vitiligo is treated with a variety of topical and systemic medications, phototherapy, laser therapy, and surgical therapy. Corticosteroids, calcineurin inhibitors, and vitamin-D analogues are examples of topical treatment modalities. Phototherapy is a highly effective treatment method. It causes repigmentation in the majority of patients with early and localised disease. Because vitiligo is associated with other autoimmune disorders, a multidisciplinary approach is required. Collaboration and communication between primary care physicians and dermatologists are critical. This review aims to assess role of primary care physicians in assessment and management of vitiligo in primary care settings.

scholarly journals Dyspepsia: When and How to Test forHelicobacter pyloriInfection

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Maria Pina Dore ◽  
Giovanni Mario Pes ◽  
Gabrio Bassotti ◽  
Paolo Usai-Satta
Keyword(s):  
Primary Care ◽  
Functional Dyspepsia ◽  
Primary Care Physicians ◽  
Epigastric Pain ◽  
Noninvasive Testing ◽  
Medication History ◽  
Breath Testing ◽  
Rome Iii ◽  
History Of ◽  
H Pylori

Dyspepsia is defined as symptoms related to the upper gastrointestinal tract. Approximately 25% of western populations complain of dyspeptic symptoms each year. 70% of them do not have an organic cause and symptoms are related to the so-called functional dyspepsia, characterized by epigastric pain, early satiety, and/or fullness during or after a meal occurring at least weekly and for at least 6 months according to ROME III criteria. In order to avoid invasive procedures and adverse effects, to minimize costs, to speed up diagnosis, and to provide the most appropriate treatments, primary care physicians need to recognize functional dyspepsia. Because symptoms do not reliably discriminate between organic and functional forms of the disease, anamnesis, family history of peptic ulcer and/or of gastric cancer, medication history, especially for nonsteroidal anti-inflammatory drugs, age, and physical examination could help the physician in discerning between functional dyspepsia and organic causes. For patients without alarm symptoms, noninvasive testing forH. pylori, with either carbon-13-labeled urea breath testing or stool antigen testing, is recommended as a first-line strategy. In this review, we provide recommendations to guide primary care physicians for appropriate use of diagnostic tests and forH. pylorimanagement in dyspeptic patients.

scholarly journals Intra-cardiac cement embolism during hip arthroplasty

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Alexander Amir ◽  
◽  
David Bracco ◽  
Gabriele Baldini ◽  
André Denault ◽  
...  
Keyword(s):  
Treatment Options ◽  
Coronary Bypass ◽  
Aortic Valve Area ◽  
Hemodynamic Compromise ◽  
Neck Fracture ◽  
Cement Embolism ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Hemi Arthroplasty

A 92-year-old woman presented to the operating room with a right femoral neck fracture. She had a past medical history significant for atrial fibrillation, coronary artery disease with a history of coronary bypass, severely stenotic aortic valve (area 0.9 cm2), diabetes, dyslipidemia, hypertension and dementia. She underwent general anesthesia with continuous Transesophageal Echocardiographic (TEE) monitoring for a right hemi-arthroplasty. While cementing the prosthesis, small cement emboli were initially seen (ME ascending aorta SAX view) migrating in the pulmonary artery (Figure A*). Subsequently, a large (4 cm) cement embolus was visualized in the right atrium, adhered to the Eustachian valve, an embryonic remnant (Figure B*, supplementary video A). The patient experienced no significant hemodynamic compromise or issue with gas exchange. Given embolization risk and severe potential for harm, intervention may be indicated. Treatment options were discussed but given hemodynamic stability, patient age and comorbidities, the patient was monitored without further intervention.

scholarly journals Primary Care in the USA: The Long Struggle to Build its Foundational Role

2021 ◽  
Author(s):  
John Geyman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Access To Health Care ◽  
Universal Access ◽  
Reform Initiatives ◽  
Access To Health ◽  
The Usa ◽  
History Of ◽  
Current Reform

Family practice was recognized as the 20th specialty in American medicine in 1969. With the hope that primary care would become the foundation of an improved health care system, vigorous efforts were launched in medical education, research and practice to achieve that goal. This chapter traces the history of that effort, together with negative system changes that have obstructed that goal. Although primary care physicians have been shown to improve access to care, contain costs, decrease inequities, and improve patient outcomes, they are still too few in number to meet national needs for primary care. The COVID-19 pandemic revealed the extent of inadequacy and vulnerability of the system. The U. S. still lacks a system of universal access as has been in place for many years in most other advanced countries around the world. Corporate stakeholders in a largely privatized financing and delivery system continue to challenge the future of primary care. Lessons from the failure of reform initiatives over the last 50 years are discussed, as are current reform alternatives, only one of which would at last bring universal access to health care in this country.

scholarly journals Alarming triad of progressive hoarseness in a male smoker

2021 ◽  
Vol 16 (3) ◽  
pp. 119-122
Author(s):  
Nur Ain Nabila Za'im ◽  
Mawaddah Azman
Keyword(s):  
Primary Care ◽  
Laryngeal Cancer ◽  
Primary Care Physicians ◽  
Glottic Carcinoma ◽  
Health Providers ◽  
Male Smoker ◽  
Vocal Health ◽  
Number Of Patients ◽  
Primary Care Health ◽  
History Of

Hoarseness accounts for 1% of all consultations in primary care. Suspicion of malignancy should be considered in individuals with risk factors presenting with unexplained hoarseness lasting more than two weeks. A significant number of patients with laryngeal cancer present at an advanced stage due to lack of awareness regarding vocal health. It is important to educate both the public and primary care health providers concerning laryngeal cancer. We present the case of an 81-year old male smoker who presented to us with a six-month history of progressive hoarseness. He was initially treated in two primary and one secondary care centres, where a diagnosis of laryngeal cancer was not considered. Careful assessment in our centre managed to determine a diagnosis of T3N0M0 glottic carcinoma. We will discuss this alarming triad of progressive hoarseness in a male smoker to help primary care physicians streamline their thoughts and identify red flags in a hoarse patient.

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