Chronic urticaria in childhood

2019 ◽  
Vol 12 (5) ◽  
pp. 264-270 ◽  
Author(s):  
Rachel Lee ◽  
Louise J Michaelis ◽  
Janaki Mahadevan
Keyword(s):  
Primary Care ◽  
Physical Examination ◽  
Chronic Urticaria ◽  
Symptomatic Relief ◽  
Allergy Testing ◽  
Non Invasive ◽  
Diagnostic Pathway ◽  
Specialist Referral ◽  
Targeted Screening ◽  
Proven Benefit

Chronic urticaria (CU) is characterised by recurrence of hives or angioedema almost daily for at least 6 weeks. It is benign, but can be intractable, and hence, frustrating for patients and physicians alike. Diagnosis is clinical and based primarily on an allergy-focused history and physical examination. Routine referral for allergy testing is not always required. The goal of treatment is symptomatic relief with non-sedating antihistamines. Targeted screening for nutritional deficiency is of proven benefit. Triggers of CU in childhood are varied and different from CU in adults. This article aims to update GPs on CU in children, focusing on management in primary care, guidance on specialist referral and details of the subsequent targeted diagnostic pathway with non-invasive testing undertaken by paediatricians.

Diagnosing renal disease

2021 ◽  
pp. 175573802110530
Author(s):  
Ikenna Anderson Aneke
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Renal Disease ◽  
Physical Examination ◽  
Secondary Care ◽  
Diagnostic Tools ◽  
Or Management ◽  
Detailed History ◽  
Diagnostic Pathway ◽  
High Index Of Suspicion

Making clear diagnoses of renal disease can prove challenging for the general practitioner considering the limitations in consulting time and diagnostic tools in primary care. In addition, many of these diseases are asymptomatic and a high index of suspicion is needed to make a diagnosis. As always, the diagnostic pathway begins with a detailed history, physical examination and relevant investigations. This will help determine whether the patient requires emergency referral to secondary care, referral on the cancer pathway or management within the community.

CURRENT APPROACH ON CUTANEOUS MELANOMA DIAGNOSTICS

2019 ◽  
Vol 65 (5) ◽  
pp. 638-644
Author(s):  
Mariya Ebert ◽  
Georgiy Gafton ◽  
Grigoriy Zinovev ◽  
I. Gafton
Keyword(s):  
Physical Examination ◽  
Cutaneous Melanoma ◽  
Growth Dynamics ◽  
Current Approach ◽  
Clinical Diagnostics ◽  
Skin Tumors ◽  
Steady Increase ◽  
Non Invasive ◽  
Early Stages ◽  
Other Information

Melanoma is on the first place in mortality among all skin tumors. Over the past 50 years, there has been a steady increase in the incidence of cutaneous melanoma compared to other types of tumors. Rates of 5-year survival are fairly high, if melanoma is diagnosed in the early stages, which requires adequate diagnostics and treatment. Melanoma diagnostic, especially in the early stages, can be problematic even for an experienced dermatologist. However, primary contact doctor can be any specialty. Melanoma and other skin tumors can be detected by physical examination during treatment for another disease. Phenotypic risks factors, anamnestic data, and physical examination data are important in cutaneous melanoma diagnostics. The sensitivity of clinical diagnosis during a visual examination by an experienced dermatologist is approximately 70 percent. However, dermascopy can significantly increase the accuracy of a clinical diagnostics. In recent years there has been an active research for new non-invasive methods and algorithms for cutaneous melanoma diagnostics. The main goal of non-invasive diagnostics is to determine need for biopsy. This decision should be based on a combination of clinical and dermascopic examinations and other information, including growth dynamics, symptoms and medical history. Thus, an adequate diagnostic of cutaneous melanoma, including non-invasive and invasive methods, is a simple and economically viable way to early detection of cutaneous melanoma and to reduce mortality from this aggressive disease.

scholarly journals Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

2015 ◽  
Vol 9 (11-12) ◽  
pp. 387 ◽  
Author(s):  
Nathan C Wong ◽  
Rahul K Bansal ◽  
Armando J Lorenzo ◽  
Jorge DeMaria ◽  
Luis H Braga
Keyword(s):  
Primary Care ◽  
Physical Examination ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Undescended Testis ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hospital Patients

<p><strong>Introduction:</strong> Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists.</p><p><strong>Methods:</strong> We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed.</p><p><strong>Results:</strong> Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes.</p><p><strong>Conclusion:</strong> Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.</p>

scholarly journals Sulco Perineal: Uma Anomalia Congénita Rara

2016 ◽  
Vol 29 (10) ◽  
pp. 670 ◽  
Author(s):  
Manuel Barbosa ◽  
Nuno Alves ◽  
Natacha Fontes
Keyword(s):  
Primary Care ◽  
Case Report ◽  
Physical Examination ◽  
Anorectal Malformation ◽  
Newborn Girl

Perineal groove is a rare congenital anorectal malformation, with incidence yet undetermined. It is almost exclusive to the female newborn and its embryogenic origin remains uncertain. We present a case-report of a newborn girl that was discharged from the nursery without complications. At her first appointment at primary care we noted a wet sulcus connecting the posterior vaginal commissure and the anus. This case report emphasizes the rarity of the perineal groove and the importance of a good quality history and physical examination at primary care.

scholarly journals Real-world presentation with heart failure in primary care: do patients selected to follow diagnostic and management guidelines have better outcomes?

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000935
Author(s):  
Alex Bottle ◽  
Dani Kim ◽  
Paul P Aylin ◽  
F Azeem Majeed ◽  
Martin R Cowie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Initial Management ◽  
Risk Of Death ◽  
Specialist Referral ◽  
Partial Completion ◽  
General Practices ◽  
Using Data

ObjectiveTo describe associations between initial management of people presenting with heart failure (HF) symptoms in primary care, including compliance with the recommendations of the National Institute for Health and Care Excellence (NICE), and subsequent unplanned hospitalisation for HF and death.MethodsThis is a retrospective cohort study using data from general practices submitting records to the Clinical Practice Research Datalink. The cohort comprised patients diagnosed with HF during 2010–2013 and presenting to their general practitioners with breathlessness, fatigue or ankle swelling.Results13 897 patients were included in the study. Within the first 6 months, only 7% had completed the NICE-recommended pathway; another 18.6% had followed part of it (B-type natriuretic peptide testing and/or echocardiography, or specialist referral). Significant differences in hazards were seen in unadjusted analysis in favour of full or partial completion of the NICE-recommended pathway. Covariate adjustment attenuated the relations with death much more than those for HF admission. Compared with patients placed on the NICE pathway, treatment with HF medications had an HR of 1.16 (95% CI 1.05 to 1.28, p=0.003) for HF admission and 1.03 (95% CI 0.90 to 1.17, p= 0.674) for death. Patients who partially followed the NICE pathway had similar hazards to those who completed it. Patients on no pathway had the highest hazard for HF admission at 1.30 (95% 1.18 to 1.43, p<0.001) but similar hazard for death.ConclusionsPatients not put on at least some elements of the NICE-recommended pathway had significantly higher risk of HF admission but non-significant higher risk of death than other patients had.

The Use of Ozone in Dentistry and Medicine

2006 ◽  
Vol os13 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Aylin Baysan ◽  
Edward Lynch
Keyword(s):  
Primary Care ◽  
Management Strategy ◽  
Invasive Technique ◽  
Root Caries ◽  
Pharmaceutical Management ◽  
Primary Care Clinics ◽  
Best Management ◽  
Non Invasive ◽  
Carious Lesions ◽  
The World

A previous paper, recently published in Primary Dental Care, gave an overview of the medical uses of ozone and outlined some of its uses in dentistry. The current paper focuses on a description of use of ozone in the management of root caries and considers recent studies in this area. There has been relatively limited research into the non-invasive (pharmaceutical) management of root caries. The best management strategy still remains to be developed. Initial studies have indicated that an application of ozone for a period of either 10 or 20 seconds is capable of clinically reversing leathery root carious lesions. It is suggested that, subject to confirmation from extensive trials, this simple and non-invasive technique may benefit many patients with root caries throughout the world since this approach to treat root caries can easily be employed in primary care clinics and in the domiciliary treatment of home-bound elderly people and immobile patients in hospices and hospitals.

Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study

2018 ◽  
Vol 72 (11) ◽  
pp. e13253
Author(s):  
Ángel Herráiz-Adillo ◽  
Olga Piñar-Serrano ◽  
Julián Ángel Mariana-Herráiz ◽  
Vicente Martínez-Vizcaíno ◽  
Diana Patricia Pozuelo-Carrascosa ◽  
...  
Keyword(s):  
Primary Care ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Peripheral Artery Disease ◽  
Diagnostic Accuracy Study ◽  
Peripheral Artery ◽  
Primary Care Population ◽  
Accuracy Study ◽  
Artery Disease

Vision Screening

2020 ◽  
Keyword(s):  
Primary Care ◽  
Early Detection ◽  
Physical Examination ◽  
Vision Loss ◽  
Light Reflection ◽  
Primary Care Visit ◽  
Vision Screening ◽  
Care Visit ◽  
Test Instrument ◽  
Key Points

Key Points Vision screening should be a routine part of every primary care visit, with physical examination from birth and formal acuity testing from 3 years on. Elements of the physical examination include inspection, red reflex evaluation, corneal light reflection, cover-uncover test. Instrument-based testing can begin at 1 year of age until chart-based acuity testing is possible from 3 years on. Amblyopia, which results in permanent vision loss, is preventable with early detection—before 5 years of age.

Assessment

2017 ◽  
pp. 35-70
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Primary Care ◽  
Physical Examination ◽  
Therapeutic Relationship ◽  
Mental State ◽  
Assessment Methods ◽  
Assessment Process ◽  
Psychiatric Assessment ◽  
Psychiatric Interview ◽  
Detailed Review ◽  
State Examination

The psychiatric interview is at the heart of psychiatry, since it provides the cornerstone of diagnostic assessment as well as being central to establishing a therapeutic relationship. This chapter, ‘Assessment’, describes the goals, principles, and practice of psychiatric interviewing. There is a detailed review of the various components of a full psychiatric assessment (the history, mental state examination, physical examination and investigations), as well as descriptions of how the assessment process is tailored to suit different situations (e.g. in emergency departments, in primary care, or in the community). The chapter proceeds to discuss how the information collected during the assessment is recorded and communicated. The chapter ends with a description of the major standardized assessment methods and ratings scales used in psychiatry.

Otorrhoea

2020 ◽  
Vol 13 (5) ◽  
pp. 281-288
Author(s):  
Mark Newton ◽  
Paraskevi Tsirevelou
Keyword(s):  
Primary Care ◽  
Cerebrospinal Fluid ◽  
Physical Examination ◽  
Hospital Admission ◽  
Secondary Care ◽  
Common Causes ◽  
Management Guidance ◽  
Throat Symptom ◽  
The Common ◽  
Nose And Throat

The discharging ear, also known as otorrhoea, is a common ear, nose and throat symptom and defined as drainage or flow exiting the ear. The discharge can be wax, blood, pus, mucus, or cerebrospinal fluid. The underlying cause can usually be determined from the history and physical examination. Most patients with otorrhoea can be managed within primary care and do not require referral or hospital admission. This article considers the common causes of a discharging ear, appropriate management, guidance for referral of patients to secondary care and some key take home points.

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