The effect of different analytical platforms and methods on the performance of population-specific adjusted calcium equation

2020 ◽  
Vol 57 (4) ◽  
pp. 300-311 ◽  
Author(s):  
N Jassam ◽  
D Narayanan ◽  
D Turnock ◽  
G Lee ◽  
K Earp ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Value ◽  
Recent Attempt ◽  
Data Sets ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
Specific Equation ◽  
New Equation ◽  
Analytical Platforms ◽  
Adjustment Equation

Background A recent attempt to improve the diagnostic value of adjusted calcium addressed a primary care-specific adjusted calcium equation, but validated the new equation for Roche Cobas, BCG and NM-BAPTA methods only. In this study, we aim to validate a population-specific equation for other methods and platforms. Method We collected retrospective patient data-sets from 15 hospital laboratories using a range of commercially available analytical platforms and methods for calcium and albumin measurements. Raw data-sets were collected and filtered according to Payne’s criteria, and separate adjusted calcium equations were derived for hospitalized and primary care patients. Results Mean albumin and calcium results were significantly higher in primary care populations ( P <  0.0001). The prevalence of hypocalcaemia using adjusted calcium ranged between 6% and 44% for inpatient data-sets and was higher in users of BCG methods. The application of community-specific adjustment equation to primary care data-sets reduced the prevalence of hypocalcaemia (mean 1.7%, range 0.8–3.7%). Conclusion We demonstrated that the use of a community-specific calcium adjustment equation to a primary care population reduces both the percentage and the variation of hypocalcaemia between different laboratories.

scholarly journals Cross-sectional associations between inflammation, sickness behaviour, health anxiety and self-rated health in a Swedish primary care population

2019 ◽  
Vol 17 ◽  
pp. 205873921984435 ◽  
Author(s):  
Karin Lodin ◽  
Mats Lekander ◽  
Predrag Petrovic ◽  
Gustav Nilsonne ◽  
Erik Hedman-Lagerlöf ◽  
...  
Keyword(s):  
Primary Care ◽  
Interleukin 6 ◽  
Health Anxiety ◽  
Health State ◽  
Sickness Behaviour ◽  
Cross Sectional ◽  
Primary Care Population ◽  
Self Rated Health ◽  
Primary Care Patients ◽  
Low Levels

This study investigated associations between inflammatory markers, sickness behaviour, health anxiety and self-rated health in 311 consecutive primary care patients. Poor self-rated health was associated with high sickness behaviour ( ρ = 0.28, P < 0.001; ρ = 0.42, P = 0.003) and high health anxiety ( ρ = 0.31, P < 0.001; ρ = –0.32, P = 0.003). High levels of interleukin 6 were associated with poor self-rated health in men ( ρ = 0.26, P = 0.009). Low levels of interleukin-6 were associated with poor self-rated health in women ( ρ = –0.15, P = 0.04), but this association was non-significant when adjusted for health anxiety ( ρ = –0.08, P = 0.31). These results are consistent with the theory that interoceptive processes draw on both inflammatory mediators and the state of sickness behaviour in inferring health state.

scholarly journals Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data

2016 ◽  
Vol 2 (1) ◽  
pp. 00077-2015 ◽  
Author(s):  
Esther I. Metting ◽  
Johannes C.C.M. in ’t Veen ◽  
P.N. Richard Dekhuijzen ◽  
Ellen van Heijst ◽  
Janwillem W.H. Kocks ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Tree ◽  
Pulmonary Disease ◽  
External Validation ◽  
Real Life ◽  
Computer Assisted ◽  
Obstructive Pulmonary Disease ◽  
Primary Care Population ◽  
Interaction Detection ◽  
Primary Care Patients

The aim of this study was to develop and explore the diagnostic accuracy of a decision tree derived from a large real-life primary care population.Data from 9297 primary care patients (45% male, mean age 53±17 years) with suspicion of an obstructive pulmonary disease was derived from an asthma/chronic obstructive pulmonary disease (COPD) service where patients were assessed using spirometry, the Asthma Control Questionnaire, the Clinical COPD Questionnaire, history data and medication use. All patients were diagnosed through the Internet by a pulmonologist. The Chi-squared Automatic Interaction Detection method was used to build the decision tree. The tree was externally validated in another real-life primary care population (n=3215).Our tree correctly diagnosed 79% of the asthma patients, 85% of the COPD patients and 32% of the asthma–COPD overlap syndrome (ACOS) patients. External validation showed a comparable pattern (correct: asthma 78%, COPD 83%, ACOS 24%).Our decision tree is considered to be promising because it was based on real-life primary care patients with a specialist's diagnosis. In most patients the diagnosis could be correctly predicted. Predicting ACOS, however, remained a challenge. The total decision tree can be implemented in computer-assisted diagnostic systems for individual patients. A simplified version of this tree can be used in daily clinical practice as a desk tool.

Trauma and Posttraumatic Stress Disorder in a Rural Primary Care Population in South Africa

2007 ◽  
Vol 100 (3_suppl) ◽  
pp. 1115-1120 ◽  
Author(s):  
K. Peltzer ◽  
M. J. Seakamela ◽  
L. Manganye ◽  
K. G. Mamiane ◽  
M. S. Motsei ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Unexpected Death ◽  
Rural Primary Care ◽  
Primary Care Population ◽  
Life Threatening Illness ◽  
Life Threatening ◽  
Primary Care Patients ◽  
Serious Injury ◽  
A Current

The aim of this study was to assess trauma events experienced and PTSD among 250 consecutive rural primary clinic patients (all Black Africans, 24% male and 76% female; M age 31.1 yr., SD = 11.8; range 18–65 years) in South Africa using the Trauma History Questionnaire and the PTSD Checklist-Civilian Version, interview administered. Results indicated that the mean number of traumatic events reported was 3.5 ( SD = 2.9, range = 0–19) and was significantly higher among men ( M = 4.9, SD = 3.5) than women ( M = 3.0, SD = 2.6). Among the most frequently endorsed traumas among men were seeing someone seriously injured or killed (60%), serious accident (43.3%), and seeing dead bodies (43.3%), and among women natural disaster (mostly floods) (51.6%), news of a serious injury, life-threatening illness or unexpected death of someone close (31.1%), and seeing someone seriously injured or killed (30%). A current diagnosis of PTSD was found in 12.4%) of the sample. Trauma incidence figures were high ( M = 3.5) and were comparable with an urban Xhosa primary care population in South Africa ( M = 3.8). A current indicative diagnosis of PTSD of 12.4%) also compares with other studies; 19.9% among urban Xhosa primary care patients and 11.8% among American primary care patients.

scholarly journals The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

Circulation ◽  
2011 ◽  
Vol 124 (25) ◽  
pp. 2865-2873 ◽  
Author(s):  
Johannes C. Kelder ◽  
Maarten J. Cramer ◽  
Jan van Wijngaarden ◽  
Rob van Tooren ◽  
Arend Mosterd ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Physical Examination ◽  
Diagnostic Value ◽  
Additional Testing ◽  
Primary Care Patients

CONUT: a tool to assess nutritional status. First application in a primary care population

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Salinas ◽  
Emilio Flores ◽  
Alvaro Blasco ◽  
Maite López-Garrigós ◽  
Carmen Puche ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Clinical Laboratory ◽  
Primary Care Patient ◽  
Demographic Data ◽  
Health Department ◽  
Care Patient ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
Conut Score

AbstractObjectivesMalnutrition is an unfavorable prognostic factor associated with an increase in mortality, hospital stays, readmissions and resources consumption. The aim was to screen primary care patients for risk of malnutrition by using the control nutritional (CONUT) score, calculated through total lymphocytes count, serum albumin and total cholesterol, when the three markers were requested, and to compare results between primary care centers (PCC).MethodsThe clinical laboratory located in a 370-bed suburban University Community Hospital serves the Health Department inhabitants (2,34,551), attended in nine PCC. The laboratory information system (LIS) automatically calculated the CONUT score in every primary care patient over 18 years old, when all three laboratory markers were ordered by the General Practitioner. For all primary care patients, we collected demographic data, CONUT index and PCC. We classified results by PCC, and compared them.ResultsThe clinical laboratory received 74,743 requests from primary care. The CONUT score was calculated in 7,155 (12.28%) patients. Nine hundred seventy-six (13.6%) were at risk of malnutrition according to the CONUT score, mainly male (p<0.01) and over 65 (p<0.01). Detected cases of malnutrition were all mild, except 48 patients (4.9%) with moderate, and one (0.1%) with severe risk. The percentage of patients at risk of malnutrition was not significantly different among PCC, with the exception of one with patients at lower malnutrition risk.ConclusionsIt is possible to use CONUT score as a front-line population-wide laboratory marker to screen for the risk for malnutrition in primary care patients that was lower in one PCC.

scholarly journals Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245131
Author(s):  
Jennifer A. Hirst ◽  
José M. Ordóñez Mena ◽  
Chris A. O’Callaghan ◽  
Emma Ogburn ◽  
Clare J. Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Renal Function ◽  
Accurate Estimate ◽  
Secondary Outcome ◽  
Factors Associated ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
The Mean ◽  
Common Combination

Objectives To establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1–5 and transiently impaired renal function and identify factors associated with multimorbidity. Design and setting Prospective cohort study in UK primary care. Participants 861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD. Interventions Participants underwent medical history and clinical assessment, and blood and urine sampling. Primary and secondary outcome measures Multimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity. Results The mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9–76.8) in all participants and 86.6% (95%CI 83.9–89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04–0.10), increasing BMI (OR 1.15, 95%CI 1.10–1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98–1.00) with multimorbidity. Conclusions This analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

scholarly journals Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines

2020 ◽  
Vol 37 (5) ◽  
pp. 606-615 ◽  
Author(s):  
Marije van Melle ◽  
Samir I S Yep Manzano ◽  
Hugh Wilson ◽  
Willie Hamilton ◽  
Fiona M Walter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
Bowel Habit ◽  
Level Of Evidence ◽  
Primary Care Population ◽  
Abdominal Symptoms ◽  
Primary Care Patients ◽  
The Uk

Abstract Background Recently, faecal immunochemical tests (FITs) have been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC), but recommendations vary across the world. This systematic review of clinical practice guidelines aimed to determine how FITs are used in symptomatic primary care patients and the underpinning evidence for these guidelines. Methods MEDLINE, Embase and TRIP databases were systematically searched, from 1 November 2008 to 1 November 2018 for guidelines on the assessment of patients with symptoms suggestive of CRC. Known guideline databases, websites and references of related literature were searched. The following questions were addressed: (i) which countries use FIT for symptomatic primary care patients; (ii) in which populations is FIT used; (iii) what is the cut-off level used for haemoglobin in the faeces (FIT) and (iv) on what evidence are FIT recommendations based. Results The search yielded 2433 publications; 25 covered initial diagnostic assessment of patients with symptoms of CRC in 15 countries (Asia, n = 1; Europe, n = 13; Oceania, n = 4; North America, n = 5; and South America, n = 2). In three countries (Australia, Spain and the UK), FIT was recommended for patients with abdominal symptoms, unexplained weight loss, change in bowel habit or anaemia despite a low level of evidence in the symptomatic primary care patient population. Conclusions Few countries recommend FITs in symptomatic patients in primary care either because of limited evidence or because symptomatic patients are directly referred to secondary care without triage. These results demonstrate a clear need for research on FIT in the symptomatic primary care population.

scholarly journals Clinical implications of electrocardiographic bundle branch block in primary care

Heart ◽  
2019 ◽  
pp. heartjnl-2018-314295 ◽  
Author(s):  
Peter Vibe Rasmussen ◽  
Morten Wagner Skov ◽  
Jonas Ghouse ◽  
Adrian Pietersen ◽  
Steen Møller Hansen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cox Regression ◽  
Pacemaker Implantation ◽  
Bundle Branch Block ◽  
Primary Care Population ◽  
Hazard Ratios ◽  
Primary Care Patients ◽  
Cv Disease ◽  
Electrocardiogram Ecg

ObjectivesElectrocardiographic bundle branch block (BBB) is common but the prognostic implications in primary care are unclear. We sought to investigate the relationship between electrocardiographic BBB subtypes and the risk of cardiovascular (CV) outcomes in a primary care population free of major CV disease.MethodsRetrospective cohort study of primary care patients referred for electrocardiogram (ECG) recording between 2001 and 2011. Cox regression models were used to estimate hazard ratios (HR) as well as absolute risks of CV outcomes based on various BBB subtypes.ResultsWe included 202 268 individuals with a median follow-up period of 7.8 years (Inter-quartile range [IQR] 4.9–10.6). Left bundle branch block (LBBB) was associated with heart failure (HF) in both men (HR 3.96, 95% CI 3.30 to 4.76) and women (HR 2.51, 95% CI 2.15 to 2.94) and with CV death in men (HR 1.80, 95% CI 1.38 to 2.35). Right bundle branch block (RBBB) was associated with pacemaker implantation in both men (HR 3.26, 95% CI 2.74 to 3.89) and women (HR 3.69, 95% CI 2.91 to 4.67), HF in both sexes and weakly associated with CV death in men. Regarding LBBB, we found an increasing hazard of HF with increasing QRS-interval duration (HR 1.25, 95% CI 1.11 to 1.42 per 10 ms increase in men and HR 1.23, 95% CI 1.08 to 1.40 per 10 ms increase in women). Absolute 10-year risk predictions across age-specific and sex-specific subgroups revealed clinically relevant differences between having various BBB subtypes.ConclusionsOpportunistic findings of BBB subtypes in primary care patients without major CV disease should be considered warnings of future HF and pacemaker implantation.

scholarly journals Symptoms associated with inflammatory arthritis are common in the primary care population: results from the joint symptoms survey

Rheumatology ◽  
2019 ◽  
Vol 58 (11) ◽  
pp. 2009-2014 ◽  
Author(s):  
Samantha L Hider ◽  
Sara Muller ◽  
Toby Helliwell ◽  
James A Prior ◽  
Ian Scott ◽  
...  
Keyword(s):  
Primary Care ◽  
Joint Pain ◽  
Inflammatory Arthritis ◽  
Joint Stiffness ◽  
Treat To Target ◽  
Primary Care Population ◽  
Large Numbers ◽  
Joint Symptoms ◽  
Primary Care Patients ◽  
The Mean

Abstract Objectives To describe the prevalence of self-reported inflammatory joint symptoms, such as joint pain, stiffness and swelling, in UK primary care patients consulting for both musculoskeletal (MSK) and non-musculoskeletal (non-MSK) complaints. Methods A joint symptoms questionnaire survey was sent to 10 161 individuals, of whom 5050 had consulted for MSK problems. These were matched by age, gender and general practice to non-MSK consulters. Participants provided data on relevant symptoms such as joint pain, stiffness and swelling. The prevalence of these symptoms, their severity and impact were compared between MSK and non-MSK consulters. Results A total of 4549 adults responded to the survey (adjusted response 45.8%) of whom 52.3% consulted for a MSK problem. The mean (s.d.) age was 61.6 (14.8) years and 58.9% were female. Persistent (on at least half of the days in the last month) inflammatory symptoms were common even in non-MSK consulters, with 42% reporting joint pain, 36% reporting joint stiffness and 18% reporting joint swelling. This is in comparison with 62% reporting joint pain, 50% stiffness and 24% swelling among MSK consulters. Conclusions Although symptoms such as persistent joint pain, swelling and stiffness are predictive of inflammatory arthritis, large numbers of people consulting primary care for non-MSK reasons report these symptoms when asked by questionnaire. This compounds the challenges of diagnosing inflammatory arthritis in a non-specialist setting where new approaches are needed to ensure accurate, early diagnosis, facilitating a treat-to-target approach.

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