scholarly journals Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians

2020 ◽  
Vol 11 ◽  
pp. 215013272090418 ◽  
Author(s):  
Garret A. Horton ◽  
Matthew T. W. Simpson ◽  
Michael M. Beyea ◽  
Jason A. Beyea
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
English Language ◽  
Family Physicians ◽  
Neck Surgery ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Evidence Based ◽  
The Cochrane Library ◽  
Cerumen Removal

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

Extracts from The Cochrane Library: Antibiotics for acute maxillary sinusitis

2008 ◽  
Vol 139 (4) ◽  
pp. 486-489 ◽  
Author(s):  
Martin J. Burton ◽  
Ronald B. Kuppersmith ◽  
Richard M. Rosenfeld
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Primary Care Setting ◽  
Maxillary Sinusitis ◽  
Cochrane Review ◽  
Clinical Decision ◽  
Neck Surgery ◽  
Cochrane Library ◽  
The Cochrane Library

The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled “Antibiotics for acute maxillary sinusitis,” which concludes a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days.

scholarly journals Eficácia dos corticoides orais no alívio dos sintomas da síndroma do canal cárpico: qual a evidência atual?

2021 ◽  
Vol 37 (2) ◽  
pp. 122-131
Author(s):  
Nuno Teles Pinto ◽  
◽  
João Soares Teles ◽  
Vânia Ferreira Fernandes ◽  
Maria João Serra ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Carpal Tunnel Syndrome ◽  
Practice Guidelines ◽  
Family Physicians ◽  
Cochrane Library ◽  
Evidence Based ◽  
Tunnel Syndrome ◽  
Based Medicine ◽  
De Medicina

Introdução: A síndroma do túnel cárpico (STC) é causada pela compressão do nervo mediano no seu trajeto através do túnel cárpico e é a neuropatia mais frequente do membro superior. Objetivo: Rever e analisar a evidência atual sobre a eficácia dos corticoides orais no alívio dos sintomas em pacientes com síndroma do túnel cárpico. Material e métodos: Pesquisa de guidelines (GL), ensaios clínicos aleatorizados e controlados (ECA), revisões sistemáticas (RS) e meta-análises (MA), publicadas entre 2009 e 2019, nas bases de dados e sítios de medicina baseada na evidência da PubMed, da Cochrane Library, DARE, Bandolier, TRIP Database, BMJ Evidence-Based Medicine, National Guideline Clearinghouse, NICE, Canadian Medical Association Practice Guidelines Infobase e Primary Care Clinical Practice Guidelines, utilizando-se os descritores MeSH: ‘carpal tunnel syndrome’ e ‘corticosteroids’. Foi aplicada a escala Strength of Recommendation Taxonomy (SORT), da American Academy of Family Physicians, para atribuição dos níveis de evidência (NE) e das forças de recomendação (FR). Resultados: Dos 172 artigos devolvidos da pesquisa efetuada foram selecionados seis: um ECA, quatro RS e uma norma de orientação clínica (NOC). A eficácia dos corticoides orais a curto-médio prazo no alívio sintomático da STC é evidenciada por vários ECA e RS metodologicamente bem concebidos. Na maioria dos estudos a administração oral de 20mg de prednisolona por duas semanas conduz ao alívio temporário dos sintomas. Conclusões: A corticoterapia oral pode ser usada no alívio temporário dos sintomas do STC a curto prazo, num regime de 20mg diários de prednisolona durante duas semanas (SORT A). O seu uso no tratamento a médio e a longo prazo apresenta um nível de evidência mais baixo (SORT B).

scholarly journals Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044372
Author(s):  
Mat Nawi Zanaridah ◽  
Mohd Noor Norhayati ◽  
Zakaria Rosnani
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Sectional Study ◽  
Primary Care Practitioner ◽  
Cross Sectional ◽  
Primary Care Practitioners ◽  
Based Medicine

ObjectivesTo determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.SettingThis cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.ParticipantsThe study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.ResultsA total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.ConclusionsAlthough many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

Evidence-Based Podiatric Medicine

2009 ◽  
Vol 99 (3) ◽  
pp. 260-266 ◽  
Author(s):  
Fiona Hawke ◽  
Joshua Burns ◽  
Karl B. Landorf
Keyword(s):  
Systematic Reviews ◽  
Medical Literature ◽  
Cochrane Collaboration ◽  
The United States ◽  
Evidence Base ◽  
Cochrane Library ◽  
Free Access ◽  
Evidence Based ◽  
User Friendliness ◽  
The Cochrane Library

Due to the exponential increase in the quantity and quality of podiatric medicine–related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. The Cochrane Collaboration is an international not-for-profit organization created to improve the user-friendliness and accessibility of medical literature mainly through preparing and maintaining systematic reviews of health-care interventions. The Cochrane Library currently contains more than 50 podiatric medicine–relevant systematic reviews summarizing and synthesizing evidence from many hundreds of randomized controlled trials evaluating interventions for foot problems. Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice. (J Am Podiatr Med Assoc 99(3): 260–266, 2009)

Teaching Normal and Abnormal Behavior to Primary Care Physicians

1994 ◽  
Vol 24 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Uriel Halbreich
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Human Behavior ◽  
Primary Care Physicians ◽  
Family Physicians ◽  
Abnormal Behavior ◽  
General Internists ◽  
Education Committee ◽  
Personal Skills

Objective: This article delineates the framework for a curriculum on psychiatry, normal and abnormal human behavior for primary care physicians (PCPs). Methods: Curricula have been surveyed. Members of the Education Committee of the Association of Medicine and Psychiatry, as well as Family Physicians and General Internists involved in education have been consulted. Their recommendations are integrated. Results and Conclusions: The curriculum should be developed according to the needs of PCPs and from their perspective. Patient and problem-oriented, its content can be divided into: a) personal skills that should be developed; and b) knowledge of symptoms, their differential diagnosis (DDX) and management within the PCP's, facilities and abilities.

scholarly journals Teaching Skin Cancer Detection to Medical Students Using a Dermoscopic Algorithm

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Peggy R. Cyr ◽  
Wendy Craig ◽  
Hadjh Ahrns ◽  
Kathryn Stevens ◽  
Caroline Wight ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Skin Cancer ◽  
Primary Care Physicians ◽  
Survival Rates ◽  
Family Physicians ◽  
Skin Lesions ◽  
Posttest Score ◽  
Malignant Skin ◽  
Attending Physicians

Introduction: Early detection of melanoma skin cancer improves survival rates. Training family physicians in dermoscopy with the triage amalgamated dermoscopic algorithm (TADA) has high sensitivity and specificity for identifying malignant skin neoplasms. In this study we evaluated the effectiveness of TADA training among medical students, compared with practicing clinicians. Methods: We incorporated the TADA framework into 90-minute workshops that taught dermoscopy to family physicians, primary care residents, and first- and second-year medical students. The workshop reviewed the clinical and dermoscopic features of benign and malignant skin lesions and included a hands-on interactive session using a dermatoscope. All participants took a 30-image pretest and a different 30-image posttest. Results: Forty-six attending physicians, 25 residents, and 48 medical students participated in the workshop. Mean pretest scores were 20.1, 20.3, and 15.8 for attending physicians, resident physicians and students, respectively (P<.001); mean posttest scores were 24.5, 25.9, and 24.1, respectively (P=.11). Pre/posttest score differences were significant (P<.001) for all groups. The medical students showed the most gain in their pretest and posttest scores. Conclusion: After short dermoscopy workshop, medical students perform as well as trained physicians in identifying images of malignant skin lesions. Dermoscopy training may be a valuable addition to the medical school curriculum as this skill can be used by primary care physicians as well as multiple specialists including dermatologists, gynecologists, otolaryngologists, plastic surgeons, and ophthalmologists, who often encounter patients with concerning skin lesions.

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