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.

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.

scholarly journals Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement?

2020 ◽  
Vol 8 (5) ◽  
pp. 607-620
Author(s):  
NF van Erp ◽  
CW Helsper ◽  
P Slottje ◽  
D Brandenbarg ◽  
FL Büchner ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Primary Care ◽  
Confidence Interval ◽  
Secondary Care ◽  
Interval Duration ◽  
Diagnostic Pathway ◽  
Long Duration ◽  
Time To Diagnosis ◽  
Diagnostic Interval ◽  
Upper Gastrointestinal

Background An efficient diagnostic pathway and early stage diagnosis for cancer patients is widely pursued. This study aims to chart the duration of the diagnostic pathway for patients with symptomatic oesophageal and gastric cancer, to identify factors associated with long duration and to assess the association of duration with tumour stage at diagnosis. Methods This was a retrospective cohort study, using electronic health records of six routine primary care databases covering about 640,000 patients, partly linked to the Netherlands Cancer Registry. Symptomatic patients with oesophageal and gastric cancer (2010–2015) that presented in primary care were included. Duration of four diagnostic intervals was determined: patient interval; first symptoms to primary care consultation, primary care interval; consultation to referral, secondary care interval; referral to diagnosis, and the diagnostic interval; consultation to diagnosis. Characteristics associated with ‘long duration’ (≥P75 duration) were assessed using log-binomial regression. Median durations were stratified for tumour stages. Results Among 312 symptomatic patients with upper gastrointestinal cancer, median durations were: patient interval: 29 days (interquartile interval 15–73), primary care interval: 12 days (interquartile interval 1–43), secondary care interval: 13 days (interquartile interval 6–29) and diagnostic interval: 31 days (11–74). Patient interval duration was comparable for patients with and without alarm symptoms. Absence of cancer-specific alarm symptoms was associated with ‘long duration’ of primary care interval and secondary care interval: relative risk 5.0 (95% confidence interval 2.7–9.1) and 2.1 (95% confidence interval 1.3–3.7), respectively. Median diagnostic interval duration for local stage disease was 51 days (interquartile interval 13–135) versus 27 days (interquartile interval 11–71) for advanced stage ( p = 0.07). Conclusion In the diagnostic pathway of upper gastrointestinal cancers, the longest interval is the patient interval. Reducing time to diagnosis may be achieved by improving patients’ awareness of alarm symptoms and by diagnostic strategies which better identify cancer patients despite low suspicion.

scholarly journals Navigating possible endometriosis in primary care: a qualitative study of GP perspectives

2021 ◽  
pp. BJGP.2021.0030
Author(s):  
Sharon Dixon ◽  
Abigail McNiven ◽  
Amelia Talbot ◽  
Lisa Hinton
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Qualitative Study ◽  
Wide Spectrum ◽  
Initial Presentation ◽  
Therapeutic Interventions ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Telephone Interviews

Background: Endometriosis affects approximately 10% of women, with well-documented delays between initial presentation with symptoms and diagnosis. In England, women typically seek help first in primary care, making this setting pivotal in women’s pathways to diagnosis and treatment. English General Practitioner (GP) perspectives on managing possible endometriosis have not been previously reported. Aim: To explore what GPs identify as important considerations when caring for women with symptoms that raise the possibility of endometriosis. Design and Setting: English primary care. Method: Semi-structured scenario-based telephone interviews with 42 GPs based around a fictional scenario of a woman presenting to primary care with symptoms suggesting possible endometriosis. Interviews were thematically coded and analysed. Results: Managing possible endometriosis in primary care brings challenges. While knowledge and awareness were pre-requisites for considering endometriosis, other important considerations were raised. Symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. GPs move through a diagnostic hierarchy to exclude sinister causes and utilise trials of treatment as both therapeutic interventions and diagnostic tools – processes which take time. An endometriosis label or diagnosis has advantages and risks. GPs reported sharing decisions about investigation and referral whilst holding women’s priorities as pivotal. These conversations were underpinned by their knowledge of uncertainties and unknowns, including the wide spectrum and unpredictability of endometriosis. Conclusion: GPs considerations are more complex than simply lacking awareness. The unknowns surrounding endometriosis matter to GPs. Further research and tailored resources for primary care, where women present with undifferentiated symptoms, are needed.

scholarly journals Acceptability of Physician Associate Interns in Primary Care: Results from a Service Evaluation

2020 ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Secondary Care ◽  
Service Evaluation ◽  
Full Potential ◽  
Primary Care Workforce ◽  
Form Part ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

Abstract Background: Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner recruitment and retention crisis. However, they are novel to the primary care workforce, have limitations such as being unable to prescribe and order ionising radiation investigations, and there are very limited directly-relevant data to guide the integration of PAs into primary care. To address this, a novel internship scheme was established in Staffordshire to support PAs entering primary care. This evaluation was designed to establish the acceptability of Physician Associate (PA) Interns within primary care.Methods: The Staffordshire PA Internship (SPAI) scheme was introduced in Staffordshire in 2017. PAs were concurrently working in primary and secondary care posts for one year, with protected weekly education sessions to equip them for work in primary care. Within the nine primary care practices hosting 10 PA interns in the first two cohorts, the PA interns, supervising GPs and practice managers, and patients who attended an appointment with a PA intern were invited to participate in the evaluation.Results: By evaluation end, eight of the ten PAs had completed the internship. Overall PA interns were acceptable to practices and patients, however there was ambiguity about the PA role itself, and how best to communicate this, as well as how to operationalise their roles. An expectation-preparedness gap was identified for PAs working in primary care. This resulted in high levels of supervision required for PA interns early within the internship. The internship provided a platform upon which the expectation-preparedness gap could be closed and made the high supervision requirements more acceptable to practices.Conclusions: This test-of-concept SPAI has highlighted that, to ensure successful integration of new PAs into primary care and to support them to reach their full potential, commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision, need to be delivered. Without such investment, there is a risk that acceptability of PAs in primary care, and PAs’ views of primary care careers, will be undermined before the profession has attained its full potential.

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.

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.

scholarly journals Atypical presentation of testicular torsion: a case series

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Uzodimma Ejike Onwuasoanya
Keyword(s):  
Physical Examination ◽  
Testicular Torsion ◽  
Age Groups ◽  
Case Series ◽  
Atypical Presentation ◽  
Testicular Pain ◽  
Future Fertility ◽  
Urological Emergency ◽  
High Index Of Suspicion ◽  
Symptoms And Signs

Abstract Background Testicular torsion is a urological emergency and needs urgent intervention to prevent testicular loss and impaired future fertility. It is commonly seen in the neonatal and adolescent age groups. Testicular torsion can also present outside these common age groups with uncommon symptoms and signs. We report case series of patients managed at Lily Hospitals Limited, Warri, Delta State, Nigeria with atypical presentation of testicular torsion. Case Presentation The first patient was a 35-year-old male that presented with recurrent right testicular pain of 1-year duration, described as dull aching with no constitutional symptoms, physical examination findings were not pathognomonic of testicular torsion, he had scrotal exploration with right orchidectomy and left orchidopexy. The second patient was a 39-year-old male who presented with recurrent right testicular pain of 4-days duration, described as dull aching with no constitutional symptoms. Physical examination findings were not classical for testicular torsion, he had scrotal exploration with bilateral orchidopexy. Conclusion Testicular torsion although common in neonatal and adolescent age groups can also present outside these age groups with uncommon symptoms and signs, a high index of suspicion is thus invaluable in any patient presenting with testicular pain despite the age and severity to avoid missing the diagnosis as this can lead to testicular loss.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

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