Managing anorexia nervosa in primary care

2021 ◽  
pp. 175573802110246
Author(s):  
Clarissa Hjalmarsson ◽  
Natasha Faye Daniels
Keyword(s):  
Primary Care ◽  
Anorexia Nervosa ◽  
Secondary Care ◽  
Psychiatric Illness ◽  
Signs And Symptoms ◽  
Vital Role ◽  
Definitive Treatment ◽  
Life Threatening ◽  
Patients Experience ◽  
Ongoing Support

Anorexia nervosa is a potentially debilitating mental illness, with significant physical and psychological sequelae. It has the highest mortality of any psychiatric illness. Early intervention is associated with better outcomes. However, patients typically experience long delays in accessing definitive treatment. Patients experience on average a three-and-a-half year delay between falling ill and accessing treatment, 6 months of which elapse between visiting a GP and receiving treatment. Patients often present to primary care either directly, with anorexia, or indirectly, with related symptoms such as amenorrhea. GPs play a vital role in recognising the signs and symptoms of this disease, identifying whether the patient has acute and potentially life-threatening symptoms, and referring them promptly and appropriately to secondary care. The current pressures on mental health services may also require GPs to provide ongoing support and management for patients while they await treatment from secondary care.

Anorexia nervosa and the gastrointestinal tract

2021 ◽  
pp. flgastro-2021-101857
Author(s):  
Wisam Jafar ◽  
James Morgan
Keyword(s):  
Anorexia Nervosa ◽  
Healthcare Professionals ◽  
Signs And Symptoms ◽  
Nutritional Therapy ◽  
Nutrition Support ◽  
Multidisciplinary Teams ◽  
High Morbidity ◽  
Support Teams ◽  
Life Threatening ◽  
Acute Admissions

Anorexia nervosa (AN) is a complex eating disorder associated with a high morbidity and mortality, however, there is a lack of dedicated training for healthcare professionals outside of mental health specialities. There has been a reported increase in acute admissions of patients with AN, which may have been precipitated by the isolation and loss of support networks created by the COVID-19 pandemic. The purpose of this review is to highlight that AN can present with a wide variety of signs and symptoms relating to both the hollow and solid organs of the gastrointestinal (GI) tract some of which may even be life threatening. The overlap of symptoms with several other functional and organic GI diseases makes diagnosis challenging. Gastroenterologists and allied healthcare professionals need to be aware of the wide array of possible GI manifestations not only to help rationalise investigations but to also facilitate early involvement of the relevant multidisciplinary teams. Many of the GI manifestations of AN can be reversed with careful nutritional therapy under the guidance of nutrition support teams.

scholarly journals Rare presentation of the great imitator: a rare case report

2017 ◽  
Vol 3 (3) ◽  
pp. 453
Author(s):  
Ravindranath Brahmadeo Chavan ◽  
Vasudha Abhijit Belgaumkar ◽  
Aarti Sudam Salunke ◽  
Sharada Shivaji Chirame
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Rare Case ◽  
Signs And Symptoms ◽  
Rare Presentation ◽  
The Past ◽  
Modern Health Care ◽  
Rare Case Report ◽  
Life Threatening ◽  
Primary Care Clinicians

<span>Syphilis is often thought to be a disease of the past, largely eradicated in modern health care; however, the rates are still extremely high in certain populations. The diagnosis of syphilis may be overlooked by primary-care clinicians due to the presence of nonspecific signs and symptoms that may be indistinguishable from other diseases. Left undiagnosed and untreated, life-threatening complications, including hepatitis, stroke, and nervous system damage, may occur particularly in immuno-compromised individuals. We present a case of lues maligna an extremely rare presentation of syphilis.</span>

Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital

2002 ◽  
Vol 21 (6) ◽  
pp. 293-295 ◽  
Author(s):  
M MD Fonseka ◽  
S L Seneviratne ◽  
C E de Silva ◽  
S B Gunatilake ◽  
H J de Silva
Keyword(s):  
Sri Lanka ◽  
Secondary Care ◽  
Heart Block ◽  
Cardiac Pacing ◽  
Complete Recovery ◽  
Definitive Treatment ◽  
Block Type ◽  
Care Hospital ◽  
Life Threatening ◽  
Degree Heart Block

Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female=55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases.

scholarly journals Fascial Space Infections

2021 ◽  
pp. 441-459
Author(s):  
Rajasekhar Gaddipati
Keyword(s):  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Jugular Vein Thrombosis ◽  
Ancient Civilization ◽  
Vein Thrombosis ◽  
Microbial Infections ◽  
Life Threatening ◽  
The Common ◽  
Fascial Space ◽  
Different Levels

AbstractDental infection has plagued humankind for as long as our civilization has been a fight against microorganisms by man dates back to ancient civilization. The discovery of antibiotics is encouraging trends conquest of the microbial infections. Infection of the deep facial spaces of the head and neck still represents a major challenge in hospitals. Untreated infections may result in abscess formation that can spread through different levels in and between the facial spaces and result in life-threatening situations including mediastinitis, pericarditis, meningitis, septic shock, airway compromise, jugular vein thrombosis, and arterial erosion, Although the complications are rare, they are serious and life threatening. The most critical point in the facial space infections is the understanding of the common and uncommon signs and symptoms, choice of antibiotics, definitive treatment and a thorough knowledge about the sequela if left unmanaged.

scholarly journals Continuity of care in heart failure patients

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Olsen ◽  
NF Falun ◽  
HK Keilegavlen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Secondary Care ◽  
Health Care Services ◽  
Care Services ◽  
Discharge From Hospital ◽  
Patients Experience

Abstract Funding Acknowledgements Type of funding sources: None. Background  Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up.  Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also  described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

Haematuria in children

2020 ◽  
Vol 13 (11) ◽  
pp. 676-681
Author(s):  
Rodrick Babakhanlou ◽  
Tom Beattie
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Microscopic Haematuria ◽  
Life Threatening

Haematuria in children can be associated with many illnesses, from the benign and self-limiting to the more complex and life-threatening. The most common form of haematuria in children is microscopic haematuria. Visible blood (also termed frank haematuria) is an uncommon, but often very distressing, finding for child and parent. Although the majority of cases are benign or less serious, it is important to identify those patients requiring referral to secondary care for further investigation and management. It is equally important to identify patients for diagnosis and appropriate management in primary care.

scholarly journals Factors shaping the implementation and use of Clinical Cancer Decision Tools by GPs in primary care: a qualitative framework synthesis

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043338
Author(s):  
Paula Theresa Bradley ◽  
Nicola Hall ◽  
Gregory Maniatopoulos ◽  
Richard D Neal ◽  
Vinidh Paleri ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Grey Literature ◽  
Signs And Symptoms ◽  
Clinical Work ◽  
Assessment Tools ◽  
Normalisation Process Theory ◽  
Decision Tools ◽  
Clinical Cancer ◽  
The Impact

ObjectiveClinical Cancer Decision Tools (CCDTs) aim to alert general practitioners (GPs) to signs and symptoms of cancer, supporting prompt investigation and onward referral. CCDTs are available in primary care in the UK but are not widely utilised. Qualitative research has highlighted the complexities and mechanisms surrounding their implementation and use; this has focused on specific cancer types, formats, systems or settings. This study aims to synthesise qualitative data of GPs’ attitudes to and experience with a range of CCDTs to gain better understanding of the factors shaping their implementation and use.DesignA systematic search of the published (MEDLINE, CINAHL, Web of Science and EMBASE) and grey literature (July 2020). Following screening, selection and assessment of suitability, the data were analysed and synthesised using normalisation process theory.ResultsSix studies (2011 to 2019), exploring the views of GPs were included for analysis. Studies focused on the use of several different types of CCDTs (Risk Assessment Tools (RAT) or electronic version of RAT (eRAT), QCancer and the 7-point checklist). GPs agreed CCDTs were useful to increase awareness of signs and symptoms of undiagnosed cancer. They had concerns about the impact on trust in their own clinical acumen, whether secondary care clinicians would consider referrals generated by CCDT as valid and whether integration of the CCDTs within existing systems was achievable.ConclusionsCCDTs might be a helpful adjunct to clinical work in primary care, but without careful development to legitimise their use GPs are likely to give precedence to clinical acumen and gut instinct. Stakeholder consultation with secondary care clinicians and consideration of how the CCDTs fit into a GP consultation are crucial to successful uptake. The role and responsibilities of a GP as a clinician, gatekeeper, health promoter and resource manager affect the interaction with and implementation of innovations such as CCDTs.

Platelet disorders

2021 ◽  
pp. 175573802199674
Author(s):  
Dominique Jade Forrest
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Platelet Function ◽  
Vital Role ◽  
Initial Assessment ◽  
Excessive Bleeding ◽  
Underlying Condition ◽  
Vast Array ◽  
Life Threatening ◽  
Platelet Disorders

Platelets play a vital role in haemostasis; therefore, an increase or decrease in levels or a disorder of platelet function can lead to symptoms such as easy bruising and excessive bleeding, particularly from mucocutaneous sites. Patients may also report symptoms associated with the underlying condition. Platelet disorders pose a particular challenge for primary care, due to the vast array of potential causes and clinical outcomes, ranging from little effect to life-threatening problems. Initial assessment in primary care should aim to identify those requiring urgent investigation or treatment, while also determining an underlying cause and potential complications.

Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

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