The disparate management of superficial venous thrombosis in primary and secondary care

2014 ◽  
Vol 30 (3) ◽  
pp. 172-179 ◽  
Author(s):  
Tristan RA Lane ◽  
Kaji Sritharan ◽  
J Rosalind Herbert ◽  
Ian J Franklin ◽  
Alun H Davies
Keyword(s):  
Venous Thrombosis ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Symptomatic Treatment ◽  
Benign Condition ◽  
Electronic Survey ◽  
The United Kingdom ◽  
Inflammatory Drugs ◽  
E Mail

Objectives Superficial venous thrombosis is common and traditionally considered a benign condition requiring only symptomatic treatment. Recent evidence, however, advocates more aggressive management. Extensive guidance is available but actual practice is unknown. This study aimed to assess the management of superficial venous thrombosis by general practitioners (primary care physicians) and vascular surgeons. Methods A 19-question validated electronic survey was created and circulated by e-mail to general practitioners and vascular surgeons in the United Kingdom. The survey evaluated presentation, investigation and treatment of superficial venous thrombosis. Results Three hundred sixty-nine surveys were returned from 197 vascular surgeons and 172 general practitioners. Most clinicians saw less than 20 cases a year, with 40% of clinicians not performing any investigations. Venous duplex was the investigation of choice in over 55%. Treatment with anti-inflammatory drugs was widespread, but anticoagulation and compression were seldom prescribed. Follow-up and treatment duration were disparate. Discussion The management of superficial venous thrombosis varies widely despite good levels of evidence and guidance. Investigation and treatment of superficial venous thrombosis show marked differences both between and within groups. Improvements in education are required to optimise the treatment pathway and advance patient care.

Deep Venous Thrombosis of the Upper Limbs

1988 ◽  
Vol 3 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Haim Gutman ◽  
Meir Peri ◽  
Avigdor Zelikovski ◽  
Menashe Haddad ◽  
Raphael Reiss
Keyword(s):  
Natural History ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Surgical Approach ◽  
Symptomatic Treatment ◽  
Consensus Conference ◽  
Natural Course ◽  
Upper Limbs ◽  
Fibrinolytic Agents

Deep venous thrombosis of the upper limbs is rare and represents less than 2-3% of all cases of deep venous thrombosis. Reviewing our series of 25 patients we decided that follow-up and symptomatic treatment produce acceptable results, since the disease has a benign natural history. Fibrinolytic agents administered under strict limitations (The Consensus Conference 1980, Ann Int Med) are efficient in early cases, but its ability to change the natural course of the disease has not been proved. Surgical approach should be reserved for cases with secondary ischaemia and/or a resectable extraluminal mass.

scholarly journals Guillain-Barré Syndrome Presenting as Unilateral Hip Pain in a Child

2015 ◽  
Vol 44 (2) ◽  
pp. 191
Author(s):  
Charalambos Neocleous ◽  
Konstandinos Diakolios ◽  
Alkistis Adramerina ◽  
Evangelos Varveris ◽  
Vasiliki Tsioni ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Hip Pain ◽  
Guillain Barre Syndrome ◽  
Benign Condition ◽  
Wide Range ◽  
Guillain Barré Syndrome ◽  
Close Observation ◽  
Irritable Hip ◽  
Guillain Barré

<p><strong>Objective</strong>. The aim of this report is to highlight the importance of close observation and follow-up in children who present with an acutely irritable hip. This is because hip pain is a symptom of not only benign but also severe conditions. Thus, at the time of the initial presentation, hip pain can be misdiagnosed. This report serves as an example for a wide range of doctors such as orthopaedic surgeons, paediatricians, emergency room physicians or primary care physicians, because these are the first-line doctors who treat patients with a painful hip. <strong>Case report</strong>. We herein present a three-year-old child who was admitted to our hospital with pain in the right leg and initially diagnosed with<br />transient synovitis of the hip. An additional examination two days later, after severe deterioration of the clinical picture, revealed that our patient was actually suffering from Guillain-Barré syndrome. Failure to diagnose Guillain-Barré syndrome and initiating prompt treatment is potentially life-threatening. <strong>Conclusion</strong>. Clinicians should be aware that hip pain could be the presenting complaint of Guillain-Barré syndrome, a syndrome that has many clinical features. Even when all the clinical and laboratory findings indicate a benign condition, Guillain-Barré syndrome should still be considered. Therefore, close observation and follow-up in children who present with an acutely irritable hip is highly recommended. In this way, the potentially catastrophic consequences of more severe conditions can be avoided.</p>

scholarly journals The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID-19 pandemic. Temporary guidelines. Version 2

2022 ◽  
Vol 20 (8) ◽  
pp. 3172
Author(s):  
O. M. Drapkina ◽  
L. Y. Drozdova ◽  
S. N. Avdeev ◽  
S. A. Boytsov ◽  
E. S. Ivanova ◽  
...  
Keyword(s):  
General Practitioners ◽  
Primary Care Physicians ◽  
Communicable Diseases ◽  
Clinical Aspects ◽  
Non Communicable Diseases ◽  
Family Doctors ◽  
National Medical ◽  
Coronavirus Infection ◽  
Overall Mortality

Guidelines were approved at the meeting of the academic council of the National Medical Research Center for Therapy and Preventive Medicine, Moscow (Protocol No. 10 of 19.10.2021).The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic non-communicable diseases in the conditions of the new coronavirus infection (COVID-19) pandemic, including the use of telemedicine technologies.The organization and conduct of high-quality medical follow-up are the most important tasks aimed at both reducing the risks of developing complications of chronic non-communicable diseases and reducing overall mortality, especially in the current conditions of the COVID-19 pandemic. The guidelines contain clinical aspects of dispensary follow-up, general principles of tactics for managing patients with various chronic non-communicable diseases in COVID-19 conditions, in addition, brief checklists with options for interviewing patients with various chronic non-communicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic non-communicable diseases with antiviral drugs are considered.The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care.

scholarly journals Oral corticosteroid prescription patterns for asthma in France, Germany, Italy and the UK

2020 ◽  
Vol 55 (6) ◽  
pp. 1902363 ◽  
Author(s):  
Trung N. Tran ◽  
Elizabeth King ◽  
Rajiv Sarkar ◽  
Cassandra Nan ◽  
Annalisa Rubino ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Primary Care Physicians ◽  
Western Europe ◽  
Uncontrolled Asthma ◽  
The United Kingdom ◽  
Asthma Exacerbations ◽  
Oral Corticosteroids ◽  
Baseline Characteristics ◽  
The Uk

Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe.We used electronic medical records from databases in France, Germany, Italy and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, at least one non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status.Of 702 685 patients with asthma, 14–44% were OCS users and 6–9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was ∼3%. High OCS users had a mean of between one and three annual OCS prescriptions, with an average daily OCS dosage of 1.3–2.2 mg. For patients who continued to meet the high-use definition, daily OCS exposure was generally stable at 5.5–7.5 mg for ≥2 years, increasing the risk of adverse effects.Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma.

scholarly journals Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e188-e194
Author(s):  
Anette Arbjerg Højen ◽  
Thure Filskov Overvad ◽  
Mads Nybo ◽  
Thomas Kümler ◽  
Morten Schnack Rasmussen ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Nationwide Survey ◽  
Recruitment Strategy ◽  
Free Text ◽  
National Guidelines ◽  
Electronic Survey ◽  
Geographical Regions ◽  
Almost All ◽  
Diagnostic Scores

Abstract Background Treatment patterns for cancer-associated venous thrombosis (CAT) has been shown to be nonconsistent with contemporary guideline recommendations, resulting in poor patient outcomes. Objectives The study aimed to describe contemporary CAT management in Danish oncology departments and identify knowledge gaps and inconsistencies between guidelines and clinical practice. Patients and Methods A survey questionnaire in Danish was developed based on contemporary national guidelines. Using an open recruitment strategy, invitations to participate in the electronic survey were sent to physicians employed at oncology departments in Denmark in winter of 2018/2019. The questionnaire was based on current national guidelines and included 10 items with multiple choices and a free-text option to specify or comment. The questionnaire was pilot-tested by a junior and senior oncologist. Results A total of 142 physicians completed the survey, representing all Danish geographical regions and various seniority. The majority reported that CAT was treated and followed up in oncology departments. However, 36.6% of the physicians were unaware of the existence of designated cancer thrombosis guidelines. Risk of venous thrombosis was generally assessed without diagnostic scores. Almost all (98.6%) reported low-molecular-weight heparin to be first-line treatment for CAT. Treatment duration seemed wrongly influenced by subtype of venous thrombosis, and 44.5% responded that thromboprophylaxis among hospitalized patients was substantially underused. Conclusion The variability in the daily clinical management of CAT demonstrated through this survey indicates a potential to increase awareness of available guidelines, standardized use of inpatient thromboprophylaxis, and organized treatment and follow-up in a multidisciplinary setting, which would potentially improve management of CAT in Denmark.

scholarly journals Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takashi Chinen ◽  
Yusuke Sasabuchi ◽  
Kazuhiko Kotani ◽  
Hironori Yamaguchi
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Survivorship Care ◽  
Web Based ◽  
Care Continuum ◽  
Cancer Care Continuum ◽  
Cancer Specialists

Abstract Background Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care. Methods A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles. Results Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority. Conclusion Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

Tobacco cessation practices among primary care physicians in northern Illinois.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23054-e23054
Author(s):  
Cheryl Nocon ◽  
Mihir Bhayani ◽  
Amanda Karcioglu
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Program Implementation ◽  
Primary Care Physicians ◽  
Tobacco Cessation ◽  
Clinical Care ◽  
Electronic Survey ◽  
Clinical Support ◽  
Levels Of Support

e23054 Background: Tobacco cessation is an acknowledged key component of cancer survivorship programs, but significant barriers to program implementation exist. In a 2012 ASCO member survey, 86% of respondents agreed that tobacco cessation should be a routine part of clinical care. However, only 29% reported adequate training. A 2013 survey of physicians at NCI Cancer Centers also showed high levels of support for such programs, but only 1% of oncologists personally engaged themselves. This view is in line with ASCO guidelines that recommend cessation interventions by primary care (PCPs). There is a disconnect between the oncologist’s desire to provide high quality tobacco cessation support for cancer patients and the delegation and delivery of such support. The goal of our study is to evaluate current tobacco cessation practices of PCPs in a large integrated healthcare system. Methods: An electronic survey was sent to all PCPs (n = 165) of the NorthShore Medical Group (Northern Illinois) with questions about their views and practices regarding tobacco cessation. Results: 53 PCPs responded to the survey (response rate of 32%). 94% of respondents believe that PCPs are primarily responsible for addressing tobacco cessation with general patients. 89% believe that PCPs are also responsible for cancer patients, although 34% believe the responsibility should be shared with oncologists. 100% believe that tobacco use affects cancer outcomes in their patients, and 98% report sufficient training in providing cessation support. 90% always ask their patients about tobacco status at the initial visit; this drops to 21% at follow-up visits. For current smokers, 57% of PCPs recommend tobacco cessation all the time and 36% recommend services most of the time. Lack of patient willingness was the most frequently cited barrier to tobacco cessation efforts (74%), followed by lack of time (46%) and lack of resources (42%). Conclusions: PCPs view themselves as primarily responsible for addressing tobacco cessation with their patients but are limited by multiple factors. This primary care-based approach is endorsed by ASCO and other clinical guidelines. More financial and clinical support should be allocated for successful efforts against tobacco dependency.

scholarly journals Pharmacoeconomic effectiveness of using modern technologies in the follow-up care of patients with arterial hypertension

2019 ◽  
pp. 38-43
Author(s):  
A. Yu. Efanov ◽  
I. V. Medvedeva ◽  
S. V. Shalaev ◽  
I. M. Petrov ◽  
E. Yu. Yusupova ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
General Practitioners ◽  
Pharmacoeconomic Analysis ◽  
Active Monitoring ◽  
Total Cost ◽  
Outpatient Visits ◽  
Follow Up Care ◽  
E Mail ◽  
Modern Technologies

Aim. To conduct a pharmacoeconomic assessment of the use of modern technologies in the follow-up care of patients with arterial hypertension (AH) in the Tyumen region.Material and methods. Using a random sampling technique we selected and examined 1704 patients with AH in the Tyumen region. The average age of patients was 62±75 years, 31,5% were men. Patients are divided into active monitoring and control groups. Weekly sms and e-mail messages with prevention information were sent to patients of the active monitoring group. General practitioners receive a course of training seminars on the features of follow-up observation of patients with AH. After 12 months (±3,2), the patients had repeated examination. We conducted pharmacoeconomic analysis of the intervention.Results. The results of our study showed that the total cost of the disease with active follow-up of patients with AH decreases, which mainly occurs due to indirect expenses. Weekly sms and e-mail notification of patients in combination with educational seminars for general practitioners and cardiologists leads to a change in the structure of expenses for the treatment of patients with AH. We noticed reducing the cost of inpatient treatment, emergency calls, and a decrease in indirect expenses. On the other hand, there is a redistribution of funds spent on pharmacotherapy and cases of outpatient visits. Such redistribution, combined with a decrease in the total cost of the disease, leads to savings in the resources of the health care system and allows an additional 231 patients to be treated within 12 months.Conclusion. The proposed model of active follow-up is economically viable, both by reducing the total cost of the disease, and by redistributing funds towards using pharmacotherapy and outpatient visits, which is the most rational in the treatment of AH.

scholarly journals EP.WE.1Hybrid Surgical Hot Clinic (HSHC): evaluation of Surgical Hot Clinic services during COVID-19 lockdown

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adeel Abbas Dhahri ◽  
Raheel Ahmad ◽  
Bilal Fazal Shaikh ◽  
Olubunmi Sajinyan ◽  
Ibrahim Warrag ◽  
...  
Keyword(s):  
Emergency Service ◽  
Symptomatic Treatment ◽  
Radiology Department ◽  
Outpatient Basis ◽  
Surgical Service ◽  
Face To Face ◽  
The United Kingdom ◽  
Novel Coronavirus ◽  
Discharge From Hospital

Abstract Aims Surgical Hot Clinic (SHC) is an acute emergency service for management provided on an outpatient basis in the United Kingdom. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we modified SHC service to mainly provide telephonic follow-up with an occasional face-to-face service. Methods After developing a local pathway for SHC services during COVID-19 lockdown, a quality improvement audit was conducted from 30th March till 26th May 2020. Through this pathway, telephonic consultation carried out in most patients while for selective face-to-face consultation designated Medical Ambulatory area used. The analysis then performed using SPSS version 20 to assess the serviceability of modified hybrid SHC. Results Among 149 patients, 54(36.2%) were male, and 95(63.8%) were female, referred during Coronavirus lockdown. Out of these 149, 87(58.3%) referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, either for intervention or symptomatic treatment. Conclusion Hybrid surgical hot clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like a crisis.

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